How traumatising is mechanical mucous membrane care after interventions on paranasal sinuses? A histological immunohistochemical study

OBJECTIVE: Endonasal sinus surgery lead to more or less circumscribed mucosa defects exposing the underlying bone. Healing of these wounds is accompanied by crust formation, which may be subjected to mechanical debridement. It is not known whether this wound care impaires or facilitates wound healing. METHODS: Following sinus surgery, 72 crusts were removed from the operative site after having taken endoscopic photographs choosing different postoperative intervals. Mucosal biopsies were taken from beneath the crusts. All specimen were submitted to routine 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 ventilation and drainage, causing secondary mucositis. Local care is mandatory in these cases. According to our examinations, mechanical debridement of wounds must respect the time-dependent irritability of the healing wound. There is little risk of impairing epithelization during the second week after surgery and the chance of sustaining the healing process is best.