Histopathological changes of nasal mucosa after nasal packing with Merocel

Tan, Mehmet; Bayındır, Tuba; Çiçek, Mehmet; Aslan, Mehmet; Gül, Mehmet

doi:10.1017/s0022215121004205

Cited by 3 publications

(1 citation statement)

References 13 publications

(21 reference statements)

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“…Merocel tampons induce histopathological changes in the nasal mucosa characterized by degeneration and dysplastic changes in epithelial cells in addition to inflammation and mucosal edema in the subepithelium within 24 hours of insertion. 12 Moreover, inflammation is a well-known etiology of CDI as Hayashi et al found in their study on six patients with Rathke cleft cyst. The authors discussed that the mechanism behind delayed DI occurrence can be attributed to the spreading of inflammatory chemicals from the cyst content into the area of the pituitary gland.…”

Section: Discussionmentioning

confidence: 95%

Diabetes Insipidus after Endoscopic Endonasal Pituitary Macroadenoma Resection: Correlation of Patient and Surgery-Related Risk Factors

Hosri,

Abi Zeid Daou,

Darwish

et al. 2024

J Neurol Surg Rep

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Purpose: To identify patient and surgery related factors that could predict the development of postoperative central diabetes insipidus (CDI). Methods: This is a retrospective case-control study conducted at a single-institution tertiary referral center. Patients undergoing endoscopic endonasal skull base surgery for pituitary adenoma between November 2018 and April 2023 were recruited. The main outcome measures collected include age, gender, comorbidities, tumor type, postoperative diabetes insipidus, intraoperative and postoperative cerebrospinal fluid (CSF) leak, flow of CSF leak, number of layers required for repair, the use of nasal packing, and hospital length of stay. Results: A total of 20 patients developed DI postoperatively. Patients demographic and comorbidity profile did not correlate with DI development. The encounter of an intraoperative CSF leak was correlated with post-op DI (X2(1) =18.35, p<0.001) with a RR of 2.7 (CI=1.37-5.28). The use of nasal packs was also correlated with post-op DI (X2(1) =10.17, p=0.001) with a RR of 1.8 (CI=1.15-2.87). Defects requiring a two or more layers for reconstruction also correlated with post-op DI compared to single layer repairs (X2(1) =12.15, p<0.001) irrelevant of the materials used. Development of DI post-op correlated with an increased hospital length of stay (t(64) = -3.35, p =0.001). Conclusion: The physician should be careful when evaluating patients with pituitary adenomas in the postoperative period, particularly those with intraoperative CSF leak, nasal packing, and those who underwent multilayer reconstruction of the surgical defect.

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Section: Discussionmentioning

confidence: 95%

Diabetes Insipidus after Endoscopic Endonasal Pituitary Macroadenoma Resection: Correlation of Patient and Surgery-Related Risk Factors

Hosri,

Abi Zeid Daou,

Darwish

et al. 2024

J Neurol Surg Rep

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Grundlagen und Praxis der Anwendung von Nasentamponaden in der endonasalen Chirurgie

Weber,

Sommer,

Heppt

et al. 2023

HNO

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Evaluation of sodium hyaluronate-based composite hydrogels for prevention of nasal adhesions

Padalhin,

Ryu,

Yoo

et al. 2024

Biomed. Mater.

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During the healing process after intra-nasal surgery, the growth and repair of damaged tissues can result in the development of postoperative adhesions. Various techniques have been devised to minimize the occurrence of postoperative adhesions which include insertion of stents in the middle meatus, application of removable nasal packing, and utilizing biodegradable materials with antiadhesive properties. This study assesses the efficacy of two sodium hyaluronate (SH) -based freeze-dried hydrogel composites in preventing postoperative nasal adhesions, comparing them with commonly used biodegradable materials in nasal surgery. The freeze-dried hydrogels, SH-COL1 and SH-CMC-COL1, were evaluated for their ability to reduce bleeding time, promote wound healing, and minimize fibrous tissue formation. Results showed that SH-CMC-COL1 significantly reduced bleeding time compared to both biodegradable polyurethane foam (B-PUF) and SH-COL1. Both SH-COL1 and SH-CMC-COL1 exhibited enhanced wound healing effects, as indicated by significantly greater wound size reduction after two weeks compared to the control. Histological analyses revealed significant differences in re-epithelialization and blood vessel count among all tested materials, suggesting variable initial wound tissue response. Although all treatment groups had more epithelial growth, with X-SCC having higher blood vessel count at 7 days post treatment, all treatment groups did not differ in all histomorphometric parameters by day 14. However, the long-term application of SH-COL1 demonstrated a notable advantage in reducing nasal adhesion formation compared to all other tested materials. This indicates the potential of SH-based hydrogels, particularly SH-COL1, in mitigating postoperative complications associated with nasal surgery. These findings underscore the versatility and efficacy of SH-based freeze-dried hydrogel composites for the management of short-term and long-term nasal bleeding with an anti-adhesion effect. Further research is warranted to optimize their clinical use, particularly in understanding the inflammatory factors influencing tissue adhesions and assessing material performance under conditions mimicking clinical settings. Such insights will be crucial for refining therapeutic approaches and optimizing biomaterial design, ultimately improving patient outcomes in nasal surgery.

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Histopathological changes of nasal mucosa after nasal packing with Merocel

Cited by 3 publications

References 13 publications

Diabetes Insipidus after Endoscopic Endonasal Pituitary Macroadenoma Resection: Correlation of Patient and Surgery-Related Risk Factors

Diabetes Insipidus after Endoscopic Endonasal Pituitary Macroadenoma Resection: Correlation of Patient and Surgery-Related Risk Factors

Grundlagen und Praxis der Anwendung von Nasentamponaden in der endonasalen Chirurgie

Evaluation of sodium hyaluronate-based composite hydrogels for prevention of nasal adhesions

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