DOES MECHANICAL LOCAL AFTERCARE FOLLOWING SINUS SURGERY TRAUMATIZE REGENERATING MUCOSA - A HISTOLOGICAL AND IMMUNOHISTOCHEMICAL INVESTIGATION

Objective: Endonasal sinus surgery lead to more or less circumscribed mucosa defects exposing the underlying bone. Healing of these wounds i s accompanied by crust formation, which may be subjected to mechanical debridement. It is not known whether this wound care impaires or faci litates wound healing. Methods: Following sinus surgery, 72 crusts wer e removed from the operative site after having taken endoscopic photog raphs choosing different postoperative intervals. Mucosal biopsies wer e taken from beneath the crusts. All specimen were submitted to routin e histological serial sections as well as immunohistochemical staining of epithelium. Results: Local debridement of crusts avulsed parts of epithelium in 23% of cases during the first postoperative week. There was no histological evidence of avulsed epithelium with crusts removed the second week. This figure later increased to 16%. Possible trauma to regenerating mucosa cannot be predicted solely by the appearance of crusts. Conclusion: In principle, large crusts may disturb ventilatio n and drainage, causing secondary mucositis. Local care is mandatory i n these cases. According to our examinations, mechanical debridement o f wounds must respect the time-dependent irritability of the healing w ound. There is little risk of impairing epithelization during the seco nd week after surgery and the chance of sustaining the healing process is best.