[Effects of postoperative care on wound healing after endonasal paranasal sinus surgery].
BACKGROUND
There is no standard for postoperative care after paranasal sinus surgery.


METHODS
In a prospective study we evaluated the influence of modifications of postoperative care on wound healing after paranasal sinus surgery. We used a new method of documenting the natural dynamics of wound healing after endonasal paranasal sinus surgery that combines morphing and time-lapse video. Computer-assisted morphing means transformation of one shape into another by means of two-dimensional interpolation. The computer reconstructs the changes between the single frames taken by videoendoscopy at each examination by morphing. Editing all single frames from videoendoscopy and from morphing together resulted in a 60-second video showing wound healing over a period of six months. We documented wound healing 23 operations. Twelve patients with chronic polypoid sinusitis of similar extent were documented in a similar manner. Minimal postoperative care consisted of packing the operative cavity with rubber fingers for three days and irrigation with Ems brine. The effect of long-term packing and topical application of budesonide were studied. Analysis consisted of evaluating the time-lapse videos and final flexible endoscopy of the sinuses.


RESULTS
Wound healing after complete endonasal sinus surgery varies greatly. In the first 7-12 days blood crusts covered the whole wound. Granulation was visible for 2-4 weeks. The increasingly edematous swelling reached its maximum in the 3rd-5th week and decreased in 7th-12th week. A macroscopically normal mucosa was observed from the 12th-18th weeks. Subepithelial changes occurred for longer than 6 months.


CONCLUSIONS
The following measures are recommended for decreasing postoperative granulations, edema and swelling: minimizing the surgical trauma, long-term packing with a occlusive, nonadherent material (rubber finger packing), topical steroids (Budesonide). Stenosis of paranasal sinuses due to excessive scarring could not be prevented (especially in the frontal sinus).
Weber
R
R
Klinik für HNO-Heilkunde, Kopf-, Hals- und Plastische Gesichts-chirurgie, Kommunikationsstörungen, Städtisches Klinikum Fulda.
Keerl
R
R
Huppmann
A
A
Schick
B
B
Draf
W
W
D000287:Administration, Topical; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D004724:Endoscopy; D005500:Follow-Up Studies; D005938:Glucocorticoids; D006801:Humans; D007091:Image Processing, Computer-Assisted; D009297:Nasal Mucosa / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D009298:Nasal Polyps / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D010254:Paranasal Sinus Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D012086:Reoperation; D012852:Sinusitis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D013630:Tampons, Surgical; D014057:Tomography, X-Ray Computed; D014741:Video Recording; D014945:Wound Healing / Q000502:physiology*
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids
Der Einfluss der Nachbehandlung auf die Wundheilung nach endonasaler Nasennebenhöhlenoperation.