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Endoscopic sinus surgery (ESS) is the procedure of choice for chronic rhinosinusitis (CRS). Adhesions are the most common postoperative complications, causing recurrent disease and revision surgery. Postoperative care is thus essential for the healing of the operated cavity. A wide variety of packing materials are used to prevent bleeding and adhesions postoperatively. Two main absorbable packing materials are used: Foam-based packs (e.g., Posisep and Nasopore) and gel-based packs (PureRegen Gel - PRG). The current study is a randomized, blinded, prospective analysis of cavity healing using Posisep and PRG in ESS, aiming to compare the pros and cons of the two.Patients with bilateral symmetric CRS were recruited for the study. At the end of surgery, one side was randomly packed with Posisep, whereas the other was packed with PRG. The postoperative cavity cleaning was video recorded and a blinded physician evaluated the mucosal healing.The side packed with Posisep had significantly less middle turbinate (MT) lateralization and adhesions yet dissolved significantly slower than the PRG, causing more mucosal edema. Severe MT scarring requiring recurrent medialization and adhesiolysis was exclusively observed in the PRG group. All differences were observed in the early postoperative period (up to 12 weeks after surgery). By that time, only the MT position was significantly different between groups, despite recurrent adhesiolysis and medialization.The authors recommend using Posisep for MT support only when it is unstable or lateralized. Packing the surgical cavity in other cases with PRG is more beneficial.2 Laryngoscope, 2022.

A 68-year-old male with progressive sensorineural hearing loss underwent left cochlear implant surgery. While developing the posterior tympanotomy and identifying the facial nerve mastoid segment, gentle stimulation by the nerve stimulator resulted in unexpected profuse venous bleeding. After achieving hemostasis with Surgicel and Spongostan, the posterior tympanotomy was extended exposing a large aberrant vein running parallel to the tympanic and mastoid segments of the facial nerve in the fallopian canal. Good exposure and careful palpation of the vein assisted in ruling out facial nerve hemangioma. An intraoperative decision to proceed with implantation, taking into account limited benefit from future magnetic resonance imaging, was taken. The patient had a temporary 3-month post-operative facial nerve weakness, probably from pressure applied during hemostasis. Auditory cochlear implant function was excellent. A larger than normal diameter of the tympanic and mastoid segments of the facial nerve was seen in re-reviews of the preoperative computed tomography. We believe drawing the readers' attention to this anomaly, which to the best of our knowledge has not been previously described, can assist in the choice of preoperative imaging and increase awareness of deviation from the norm of facial nerve diameter. In addition, knowledge of possible venous anomalies may aid surgeons in such intraoperative decisions.