Wednesday, March 20, 2013

Observational Experience in Post-traumatic, Postoperative Rhinosinusitis

Observational Experience in Post-traumatic, Postoperative Rhinosinusitis

While preoperative and intraoperative measures are important, observance of a series of basic recommendations during the postoperative period will guarantee success of surgery in most cases and rapid, effective recovery of the patient. The postoperative period starts during the operation itself, as the postoperative healing process will be optimized if a series of measures are taken into account during the operation (use of punches or microdebriders, preserve the healthy mucosa, choose a suitable tamponading material and use it for the optimum time, leave silastic to prevent synechiae).

The fact is that there is currently no general consensus on what should be done after polyposis or rhinosinusitis surgery to improve the outcome. There is even doubt as to whether wound care should be daily for the first 10 days, whether it is preferable to perform it twice a week or whether it should be weekly.


 Neither is there agreement concerning the frequency of inspections until a complete cure is obtained. In this case, the scientific literature is highly divergent. However, postoperative treatment should be consistent with the phases of the healing process: appearance of scabs after 10 days, obstructive lymph oedema after 30 days, mesenchymal reaction after 3 months and healing from the 3rd month onwards, with the appropriate treatments and monitoring for each phase.
It is essential to clean the area carefully to avoid infection and/or obstruction. There is also the matter of the drugs or products that may be indicated in the postoperative period. Recently, the EP3OS consensus has enabled the level of evidence or recommendation
grade to be established for the main products used in the postoperative care of nasal polyposis and rhinosinusitis. Of particular note is the benefit obtained from the administration of topical corticoids (which act more on the underlying disease than on the healing process), nasal irrigations (particularly hypertonic irrigations) and creams or gels (not ointments). Clinical evidence has also been appearing for phytotherapy, which consistently indicates the benefits that can be obtained from using certain natural products in the recovery process.

My observational experience in postoperative care with cyclamen extract is based above all on 28 patients who underwent ethmoidectomies for polyposis. In 14 cases, saline irrigations were used, while in the remaining 14, a cyclamen extract was administered intranasally
in addition to the irrigations. One spray was administered into each nostril, once a day. The treatment was started on the third day after withdrawing Merocel. The patients treated with the cyclamen extract
experienced a significant improvement in the evolution of the cavities after the sixth day of the postoperative period (third day of treatment).
Only one case of frontal pain caused by frontal sinusitis, requiring discontinuation of the treatment, has been documented.
The endoscopic images of the nasal passages of a case of sinonasal polyposis with superinfection show how abundant mucus from the
maxillary sinus appears only a few minutes after administration of this product. In the patients treated with cyclamen extract, the maxillary sinus is clear after 48 hours, due to the product’s self-cleansing effect. 
By the 4th day after starting treatment, recovery of the affected area is obvious. By the 6th day, there is a clear retention of the mucosal oedema (when normally this happens after 10-12 days); this effect could be due to use of this preparation.
The side effects observed with this product are limited to a smarting sensation during the first few sprays, which is variable or even absent in operated patients. Other side effects may be sneezing and watery rhinorrhoea.
Generally speaking, these effects are mild, transient, expected, rare, with minimal clinical significance.

Treatment can be started on the day after surgery or when the tamponade is removed and there is no risk of bleeding.
The reason for using Nasodren  only once a day is basically because it induces a very strong expression of mucoid cells. Consequently, readministering after 12 hours would not provide any significantly greater benefit than that obtained by administering every 24 hours.
This treatment can be continued without problems for more than a week. Since it causes no significant adverse effects, it can be used for up to 10-15 days.
Cyclamen extract may be useful in all patients who require postoperative care, provided that there is healthy mucosa. Its effect would be very limited in those cases where the entire mucous membrane has been removed.
The main contraindication for this product is that it should not be used in patients with obstruction.
This treatment can be repeated as often as is wished, and can be stopped when the patient wishes.


Cyclamen extract it is my opinion that it will be very useful in clearing the surgical cavity, it will reduce the need for aggressive postsurgical wound treatments, the time between treatments of the surgical area will be longer, it will facilitate self-cleansing, it will possibly speed up the reepithelialisation process, and will enable topical corticoids to be applied earlier.

MANAGEMENT, Personal observation of Dr. H. Massegur 

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