Hypertonic versus Isotonic Saline Nasal Irrigation After Medial Maxillectomy: A Prospective Randomized Controlled Trial

Abstract

Introduction: Saline nasal irrigation is routinely recommended after sinonasal surgery, but evidence comparing isotonic and hypertonic saline after medial maxillectomy remains limited.
Aim: To compare isotonic saline (0.9% NaCl), hypertonic saline (3% NaCl), and no nasal irrigation for postoperative symptom recovery and endoscopic wound healing. Methods: In this prospective randomized controlled trial, 84 patients undergoing medial maxillectomy were randomly allocated to isotonic saline irrigation (n = 28), hypertonic saline irrigation (n = 28), or no nasal irrigation (n = 28). Sinonasal symptoms were assessed using the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire before surgery and on postoperative days 8, 10, 12, and 14. Endoscopic wound healing was assessed serially, and mucociliary clearance was evaluated using the saccharin transit test. Longitudinal changes were analyzed using mixed repeated-measures analysis of variance with Bonferroni post hoc comparisons.
Results: All groups improved during follow-up. Mixed repeated-measures ANOVA showed a significant effect of time (F = 557.835, p < 0.001) and a significant time-by-treatment interaction (F = 12.917, p < 0.001) for NOSE scores. The hypertonic saline group had the greatest reduction in NOSE scores and the most favorable endoscopic healing scores. Saccharin transit times also differed significantly among groups for both nasal cavities (both p < 0.001).
Conclusion: Hypertonic saline irrigation was associated with better early postoperative symptom scores, endoscopic healing, and mucociliary clearance than isotonic saline or no irrigation after medial maxillectomy.