Naslov
Endoscopic Monitoring of Postoperative Sinonasal Mucosa Wounds Healing

Autori
Pajić Matić, Ivana

Vrsta, podvrsta i kategorija rada
Poglavlja u knjigama, znanstveni

Knjiga
Advances in Endoscopic Surgery

Urednik/ci
Cornel Iancu

Izdavač
IntechOpen

Grad
Rijeka

Godina
2011

Raspon stranica
419-436

ISBN
978-953-307-717-8

Ključne riječi
Endoscopic Monitoring, Postoperative Sinonasal Mucosa

Sažetak
Nasal epithelium lies on the basement membrane, situated on the lamina propria. Pseudostratified columnar (respiratory) epithelium is composed of four major types of cells: ciliated cells, nonciliate cells, goblet cells and basal cells, ensuring mucus production and transport, resorption of surface materials, and formation of new epithelial cells. Lamina propria consists of two layers of seromucous glands, i.e. superficial and deep layers. Just beneath the basement membrane, lymphocytes and plasma cells form a lymphoid layer. Maintenance of normal ventilation/aeration of sinus spaces is necessary for normal functioning of paranasal sinuses. The sinus labyrinth spaces and ostia of various sinus areas can be visualized by use of endoscopic techniques, e.g., in functional endoscopic sinus surgery (FESS). Ventilation and normal sinus function can be maintained by this minimally invasive method. Endoscopic sinus surgery (ESS) is the superior surgical method of treatment for recurrent acute sinusitis, chronic sinusitis, obstructive nasal polyposis, extramucous fungal sinusitis, periorbital abscess, rhinoliquorrhea, antrochoanal polyp, foreign body extraction, mucocele, dacryocystorhinostomy, excision of various tumors of the sinuses, nose, anterior, middle and posterior cranial fossa, epistaxis control, optic nerve decompression, choanal atresia, and orbit decompression. Functional endoscopic sinus surgery (FESS), a minimally invasive technique, remains the most widely accepted therapy for chronic rhinosinusitis (CRS) and nasal polyposis (NP) after failure of medical treatment. FESS aims to remove inflammatory mucosa and to restore both ventilation and drainage of the sinus cavities. However, healing quality significantly influences the functional outcome. The exact mechanism of mucosal healing after sinus operation remains unclear. Postoperative wound healing is a highly coordinated process that includes coagulation, i.e. clot formation, inflammatory stage, and tissue formation and remodeling. During the process of healing, the extracellular matrix of nasal mucosa may be directly influenced by the growth factor (GF), while the expression of GF receptors may influence the cell phenotype and its adhesion. Endoscopic observation of the nasal and sinus mucosa healing after FESS revealed four clinical stages: stage 1 characterized by the formation of abundant crusts, lasting for 1-10 days ; stage 2 characterized by obstructive lymphedema, with pronounced swelling of residual mucosa, lasting for up to 30 days ; stage 3 characterized by mesenchymal growth, when pale, edematous mucosa is transformed to red mucosa, lasting for up to 3 months ; and stage 4 characterized by cicatrix formation, lasting for 3-6 months. The duration of particular stages can be reduced or prolonged by postoperative treatment. Any derangement in the process of healing may result in the formation of hypertrophic scar or impaired tissue differentiation, thus reducing functioning capacity of the organ involved. Healing defects of the respiratory mucosa regularly lead to development of infection or obstruction scar formation, making revision surgery necessary. Iatrogenic complication after FESS appears in 5% to 30% of patients, and recurrence is reported in about 18% of patients. Proper treatment of postoperative cavity is a significant segment in the process of mucosal healing, and thus part of the FESS. Due knowledge of the healing stages can help recognize a mucosal healing impairment and introduce appropriate therapy depending on the stage of the healing process. The healing stages and planning of postoperative therapy after endoscopic sinus surgery are presented.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA