Orlandi Richard R
Center for Therapeutic Biomaterials, Division of Otolaryngology-Head and Neck Surgery, The University of Utah, USA.
Curr Opin Otolaryngol Head Neck Surg. 2007 Feb;15(1):44-7. doi: 10.1097/MOO.0b013e328011bc9d.
Biomaterials are frequently used in the paranasal sinuses to control bleeding, promote tissue regeneration, improve healing, or prevent scarring. Few, however, have been prospectively examined in a peer-reviewed format prior to commercialization. This paper examines recent advances in biomaterials used in surgical rhinology and especially highlights some 'postmarketing' concerns.
Three biomaterials have received recent attention. The use of hydroxyapatite cement within the frontal sinus has been questioned due to recent data regarding late infection and exposure. Thrombin-gelatin paste has been shown to be effective in controlling bleeding following sinus surgery but there are conflicting data about its effect on increased scarring. Hyaluronan derivatives have also received attention, with scarring concerns again raised. Importantly, it appears that the chemical modifications of the starting material may have a significant impact on compatibility and function.
Surgeons must be aware of the potential risks and limitations of biomaterials used in rhinology. While recent and future advances in biomaterials will likely improve patients' outcomes in sinus diseases, it is apparent that currently available materials may only be a first step to that goal. More rigorous prospective evaluation of biomaterials should guide their use in the paranasal sinuses.
生物材料常用于鼻窦，以控制出血、促进组织再生、改善愈合或预防瘢痕形成。然而，很少有生物材料在商业化之前经过同行评审的前瞻性研究。本文探讨了鼻科手术中使用的生物材料的最新进展，并特别强调了一些“上市后”的问题。
三种生物材料最近受到关注。由于最近有关晚期感染和暴露的数据，额窦内使用羟基磷灰石水泥受到质疑。凝血酶 - 明胶糊剂已被证明在鼻窦手术后控制出血有效，但关于其对瘢痕增加的影响存在相互矛盾的数据。透明质酸衍生物也受到关注，瘢痕问题再次被提及。重要的是，起始材料的化学修饰似乎可能对相容性和功能有重大影响。
外科医生必须了解鼻科中使用的生物材料的潜在风险和局限性。虽然生物材料的最新和未来进展可能会改善鼻窦疾病患者的治疗效果，但显然目前可用的材料可能只是实现该目标的第一步。对生物材料进行更严格的前瞻性评估应指导其在鼻窦中的使用。
