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Keywords:

  • Endoscopic sinus surgery;
  • paranasal sinus;
  • absorbable biomaterials;
  • postoperative hemostasis;
  • rabbit

Abstract

Objectives/Hypothesis: Absorbable hemostatic agents are used routinely following sinus surgery. Recent studies suggest that current biomaterials, such as FloSeal Matrix Hemostatic Sealant (Fusion Medical Technologies, Mountain View, CA) may interfere with mucosal regeneration. This study was designed to evaluate the effects of Microporous Polysaccharide Hemospheres (MPH, Medafor, Inc., Minneapolis, MN), a novel rapidly-absorbing hemostatic powder, on healing and intact sinus mucosa.

Study Design: Prospective, controlled study using the rabbit model.

Methods: Both maxillary sinuses of 14 New Zealand white rabbits were surgically opened. The mucosa of 10 rabbits were stripped bilaterally, and the left sinus of each was then treated with either MPH or FloSeal. The mucosa of four additional rabbits were incised but otherwise remained undisturbed. Again, the left sinus of each of the four additional rabbits was treated with either MPH or FloSeal. The right sinus served as an untreated control (stripped or intact) in both arms of the study. Animals were recovered and euthanized 2 weeks later. Specimens were examined by a blinded pathologist using light microscopy.

Results: Untreated regenerated mucosa showed expected areas of sparse cilia, mild serous gland reduction, and fibrosis. MPH-treated sinuses showed no significant changes compared to respective controls, and no MPH substance was identified. In contrast, regenerating mucosa treated with FloSeal showed extensive loss of cilia, inflammation, and fibrosis. Residual FloSeal particles were present within the sinus cavity and grossly incorporated within healing mucosa. Unexpectedly, intact mucosa exposed to FloSeal showed similar findings.

Conclusions: Absorbable hemostatic materials have starkly different effects on mucosal healing. Unlike other agents, MPH is rapidly cleared and has no negative effects on healing or intact sinus mucosa.