Effect of PRF (platelete rich fibrin) application on postoperative synechies (adhesions) in patients undergoing endoscopic sinus surgery

Objective:PRF (Platelet Rich Fibrin) is an important platelet rich blood product with known benefits in wound healing. Due to this feature, its use has been increasing recently, especially by dentists, otolaryngologists, dermatologists, plastic and reconstruction surgeons. Rapid healing of the wound site after Endoscopic Sinus Surgery (ESS) is important for both patient comfort and reduction of adhesions. Reduction in adhesions is important for reducing postoperative recurrences. For this purpose, we aimed to retrospectively evaluate the nasal synechiae parameters of patients with and without PRF. Materials and Methods: In this study, we retrospectively analyzed whether the use of PRF in ESS (Endoscopic Sinus Surgery) operations performed in our clinic between 1.1.2017 and 1.1.2022 made a difference compared to the cases where PRF was not used. For this purpose, parameters such as synechiae score, endoscopic Meltzer score, endoscopic Lund-Kennedy score, Lund-Mackay Computed Tomography score, NOSE (Nasal Obstruction Symptom Evaluation) score evaluating the subjective symptoms of the patients were evaluated before and after oral steroids, preoperative period, postoperative 1,3,6 months. Inclusion criteria; Having at least two of the complaints of anterior or posterior nasal discharge, nasal obstruction, nasal drainage (mucopurulent), facial pain, pressure sensation, facial fullness and decreased or disappearance of sense of smell for more than 12 weeks in the last year and being diagnosed with chronic sinusitis with polyps unresponsive to medical treatment, The exclusion criteria were as follows: presence of findings supporting chronic rhinosinusitis on paranasal sinus CT examination performed at least one year before the operation, being older than 18 years of age, having undergone at least unsinectomy, maxillary antrostomy and anterior ethmoidectomy in both nasal cavities. Exclusion criteria were as follows: Patients with anthrochoanal polyps, more than two stages difference between the two nasal cavities according to Lund-Mackay, unilateral nasal polyposis, paranasal sinus malignancy, revision cases. Results:Fifty-three patients fulfilling these criteria were included in the evaluation. Sixteen of the patients were excluded from the study because of missing data at 6-month follow-up. Of the total patients, 17 (45.9%) were evaluated as PRF group and 20 (54.1%) as control group. In the control group, 7 (35%) of the patients were female and 13 (65%) were male, while 7 (41.2%) of the experimental group were female and 10 (58.8%) were male. Samter's triad was observed in 3 (17.6%) of the patients in the PRF group, but no patient with Samter's triad was observed in the control group. Septoplasty was performed in 13 (76.5%) patients in the control group and 10 (50%) patients in the PRF group. The mean age of the control group was 41.6±14.04 and the mean age of the control group was 45.2±14.01. There was no significant statistical difference between the age groups (p:0.537). There was one pathology with inverted papilloma foci in both PRF group and control group and all other pathologies were reported as inflammatory polyps. In the PRF group, the NOSE score was 8.00±4.41 preoperatively, 2.17±2.92 postoperative first month, 2.35±3.55 postoperative third month, and 2.58±3.39 postoperative sixth month. In the control group, NOSE score was 7.85±5.81 preoperatively, 3.00±3.06 postoperative first month, 2.25±2.55 postoperative third month, 3.60±3.85 postoperative sixth month. No superiority of PRF to the control group was observed (p>0.05). The preoperative endoscopic Meltzer score was 4.88±2.17 in the PRF group and 3.95±1.98 in the control group (p:0.141); the postoperative first month score was 1.29±1.04 in the PRF group and 1.05±1.19 in the control group (p: 0,460); postoperative third month score of the PRF group was 1.52±1.12, postoperative third month score of the control group was 1.10±1.29 (p:0,187); postoperative sixth month score of the PRF group was 1.41±1.66, postoperative sixth month score of the control group was 1.10±1.16 (p:0,798). No superiority of PRF to the control group was observed (p>0.05). Preoperative MLK score was 7.58±3.12 in PRF group and 5.90±3.04 in control group (p:0.125); postoperative first month PRF group 4.94±2.92, control group 4.30±2.34 (p: 0,537); third month PRF group 5,23±2,48, control group 4,25±2,24 (p:0,283); sixth month PRF group 4,14±2,45, control group 3,85±2,08 (p:0,821). No superiority of PRF to the control group was observed (p>0.05). The preoperative Lund-Mackay CT score was 14.11±6.10 in the PRF group and 12.20±5.69 in the control group (p:0.330); the postoperative sixth month score was 12.41±5.92 in the PRF group and 11.30±6.37 in the control group (p:0.589). No superiority of PRF to the control group was observed (p>0.05). The synechiae scores of the preoperative PRF and control groups were 0, 1.58±1.50 in the first month of the postoperative PRF group and 1.20±1.05 in the first month of the postoperative control group. Although synechiae scores of the control group were better, it was not statistically significant (p:0,497). Conclusion:PRF was not found to be superior to the control group in any parameter. In fact, better results were observed in the synechiae parameter in the control group. The reason for this was thought that PRF may increase synechiae while accelerating healing. However, it was not statistically significant. Large-scale studies with more patients are needed to have more detailed information on this subject.