الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Functional endoscopic sinus surgery (FESS) for medical refractory chronic rhinosinusitis (CRS) is well established in providing symptomatic relief and improvements in quality of life.
Postoperative wound healing plays a critical role in producing a successful result after functional endoscopic sinus surgery (FESS). The degree of inflammation within the middle meatus is critical and can influence scar tissue formation and therefore synechiae. Despite advancements in technology and training, the formation of synechiae continues to remain one of the most common causes of surgical failure in FESS. To minimize inflammation and formation of scar tissue, sinus surgeons have used various types of nasal packing between the middle turbinate and lateral nasal wall.
The innovations in nasal packing were motivated by the innate defects of conventional packings (ribbon gauze and Merocel) in quality of life during early postoperative period. Biodegradable materials have become available for intranasal packing after FESS, both for hemostatic and wound healing considerations.
The present study aimed to compare the effect of biodegradable versus non-degradable nasal packings on the outcome of FESS on clinical, endoscopic and histopathologic basis. Fifty patients with bilateral chronic rhinosinusitis were enrolled in this study at Otorinolaryngology department at Alexandria Faculty of Medicine. The patients were subjected to bilateral functional endoscopic sinus surgery using mucosal sparing technique. At the end of procedure, the operative cavity of each patient was packed with Merocel in the right side and biodegradable material in the left side.
Assessment of immediate postoperative symptoms including bleeding and patient discomfort at day one and two postoperative was done. Endoscopic follow up of the sinus mucosa was done at 1 and 3 months postoperative including biopsy taking for histopathological examination using H&E.
In the present study, post-operative bleeding and patient discomfort was significantly higher in non-degradable packing side than biodegradable side. This difference has shown more benefit of biodegradable packing.
By endoscopic evaluation of the operative cavity one and three months post-FESS, biodegradable packing has caused significantly more edema. But, no significant difference was found between the biodegradable and non-degradable regarding the synechia formation, granulation, crustation, recurrence of polyps and nasal secretions.
This study revealed no statistically significant difference between biodegradable and non-degradable packing sides regarding the inflammatory cellular population in 1 month, but it turned statistically significant 3 months post-operative.
Regarding the effect on the sinonasal epithelium, Merocel packed sides showed better epithelial restoration with marked epithelial hyperplastic changes and more goblet cells than the biodegradable sides. This difference was statistically significant 1 months post-operative, but turned non-significant 3 month post-operative. Basement membrane showed no statistical significant difference between the biodegradable and non-degradable sides. Furthermore, no signs of epithelial hyperplasia were seen neither in biodegradable nor non-degradable sides.
By histological assessment the condition of stroma of the sinonasal mucosa, edema was significantly more evident in the biodegradable than the non-degradable sides both at 1 and at 3 months post-operative. Regarding the sub-epithelial glandular activity, no statistically significant difference was found between the biodegradable and non-degradable sides at 1 and 3 months post-operative. New blood vessels formation was significantly more in the biodegradable than the non-degradable sides at 1 month post-operative, but it turned non-significant at 3 months post-operative. No foreign body giant cells were noted in neither biodegradable nor non-degradable sides at 1 and 3 months post-operative. So, biodegradable packing can reduce the post-FESS bleeding, sense of nasal obstruction and patient discomfort but, it is associated with more mucosal edema than the non-degradable packing. Otherwise, no significant difference was found between both groups regarding the quality of healing.
Therefore, the biodegradable nasal packings can offer patients a good quality of life during the early recovery period. This would be significantly better than conventional packings. Otherwise, biodegradable materials showed no beneficial or detrimental effects on postoperative mucosal healing far of variable mucosal edema. However, despite of poor quality of life in the early post-operative period, Merocel can offer less post-FESS edema providing better aeration with rapid epithelial restoration, and hence faster wound healing.