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Effect of oxidized cellulose on human respiratory mucosa and submucosa and its implications for endoscopic skull‐base approaches
Author(s) -
Goldschmidt Ezequiel,
Schneck Meghan,
Gau David M.,
Carey Lauren,
Rasmussen Jorge,
Ferreyro Bruno,
Ajler Pablo,
Snyderman Carl,
Wang Eric,
FernandezMiranda Juan,
Gardner Paul A.
Publication year - 2020
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.22495
Subject(s) - medicine , submucosa , pathology , mucous membrane of nose , necrosis , epithelium , viability assay , respiratory mucosa , cell , biology , biochemistry
Background Regenerated oxidized cellulose (ROC) sheets have gained popularity as an adjunct to a vascularized nasoseptal flap for closure of dural defects after endoscopic endonasal skull‐base approaches (EESBS). However, evidence supporting its impact on the healing process is uncertain. This study was performed to evaluate the impact of ROC on the nasal mucosa and assess its effects on tissue pH, structure, and cell viability. Methods In 5 patients, a 1‐cm 2 piece of ROC gauze was placed on the surface of the middle turbinate before it was resected as part of a standard EESBS. Mucosa treated with ROC was separated from untreated mucosa and a histologic examination of structural changes in the respiratory epithelium was performed. To assess the effect of ROC on pH, increasing amounts of ROC were added to culture medium. Nasal fibroblasts viability was assessed in the presence of ROC before and after the pH was neutralized. Results Compared with unexposed controls, treated mucosa exhibited a higher incidence of cell necrosis and epithelial cell detachment. When added to Dulbecco's modified Eagle medium, ROC caused a dose‐dependent decrease in pH of the medium. Only 1 ± 0.8% of cultured fibroblasts exposed to the ROC‐induced acidic medium were alive, whereas 98.25 ± 0.5% of the cells were viable when the pH was neutralized ( p < 0.001). Conclusion ROC applied in vivo to nasal mucosa induced epithelial necrosis likely by diminishing the medium pH, because pH neutralization prevents its effect. The ultimate effect of this material on the healing process is yet to be determined.