Richard R Orlandi1. 1. Center for Therapeutic Biomaterials, Division of Otolaryngology-Head and Neck Surgery, The University of Utah, USA. richard.orlandi@hsc.utah.edu
Abstract
PURPOSE OF REVIEW: 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. RECENT FINDINGS: 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. SUMMARY: 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.
PURPOSE OF REVIEW: 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. RECENT FINDINGS: 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. SUMMARY: 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.