title: Reduction of adhesions and antrostomy stenosis with topical vitamin A after endoscopic sinus surgery.
abstract: BACKGROUND
  Prevention of adhesion formation and restoration of mucociliary mucosa are major determinants of the success of endoscopic sinus surgery (ESS). Vitamin A (VA) can promote mucociliary differentiation of respiratory epithelium. However, whether topical VA can promote sinonasal wound healing or reduce adhesion formation after ESS in humans remains unexplored.
  
  
  OBJECTIVE
  To investigate the effect of topical VA on sinonasal wound healing and adhesion formation after ESS.
  
  
  METHODS
  This is a within-subject control study. Patients with chronic rhinosinusitis were included. Each patient underwent ESS, and topical VA was applied over the sinonasal wound. Postoperative outcomes were assessed by using the Lund-Kennedy score, and the antrostomy size was measured. In vitro wound healing assay of fibroblasts with or without VA was evaluated. Restoration of ciliated epithelium was examined by using scanning electron microscopy.
  
  
  RESULTS
  Thirty patients were enrolled. The mean (standard deviation {SD}) scores for scarring/adhesion in the VA-treated side at 3 and 12 months after surgery (0.20 ± 0.40 and 0.23 ± 0.42, respectively) were significantly lower than those in the controls (0.47 ± 0.50 and 0.53 ± 0.62, respectively). The mean (SD) antrostomy size in the VA treated side at 1, 3, and 12 months after surgery (0.85 ± 0.30 cm(2), 0.7 ± 0.30 cm(2), and 0.70 ± 0.27 cm(2), respectively) were significantly larger than those in the controls (0.79 ± 0.26 cm(2), 0.60 ± 0.25 cm(2), and 0.57 ± 0.24 cm(2), respectively). Wound healing assay revealed that VA significantly inhibited the proliferation and migration of fibroblasts. Scanning electron microscopy showed mature ciliated cells in the VA-treated side.
  
  
  CONCLUSIONS
  Topical VA is a promising agent for sinonasal wound healing after ESS because it can promote mucociliary reepithelization, reduce adhesion, and prevent antrostomy stenosis.
authors.affiliation: Graduate Institute of Basic Medical Science, College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Kai-Min
authors.initials: KM
authors.lastname: Fang
authors.forename: Chi-Te
authors.initials: CT
authors.lastname: Wang
authors.forename: Ya-Wen
authors.initials: YW
authors.lastname: Chen
authors.forename: Tsung-Wei
authors.initials: TW
authors.lastname: Huang
mesh_terms: D000287:Administration, Topical; D000328:Adult; D001706:Biopsy; D002908:Chronic Disease; D002923:Cilia / Q000648:ultrastructure; D003251:Constriction, Pathologic / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D012008:Recurrence; D012220:Rhinitis / Q000473:pathology / Q000601:surgery*; D016037:Single-Blind Method; D012852:Sinusitis / Q000473:pathology / Q000601:surgery*; D000267:Tissue Adhesions / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D016896:Treatment Outcome; D014801:Vitamin A / Q000008:administration & dosage*; D014815:Vitamins / Q000008:administration & dosage; D014945:Wound Healing / Q000187:drug effects*; D055815:Young Adult
chemical_list: D014815:Vitamins; D014801:Vitamin A