Original research-Orijinal araştırma

Cumhuriyet Tıp Dergisi Cumhuriyet Medical Journal Cumhuriyet Tıp Derg 2011; 33: 338-343 Cumhuriyet Med J 2011; 33: 338-343 Original research-Orijinal araştırma Histopathological effects of fibrin glue in maxillary sinus mucosa: An experimental study Maksiller sinüs mukozasında doku yapıştırıcılarının histopatolojik etkisi: Deneysel çalışma Elif Emine Altuntaş*, Hatice Özer, Bilal Çetin, Suphi Müderris Department of Otorhinolaryngology (Asist. Prof. E. E. Altuntaş, MD., Asist. Prof. H. Özer, MD., B. Çetin, MD., Prof. S. Müderris, MD.), Cumhuriyet University School of Medicine, TR-58140 Sivas Abstract Aim. Fibrin glue is used as a tissue adhesive and local haemostatic agent during intranasal surgeries and it also causes mechanical fastening of tissue repairing procedure. Fibrin glue is generally considered highly biocompatible and adhesive to tissue surfaces, but it has very low cohesive strength. The aim of this study was to assess the histopathological effects of fibrin glue in maxillary sinus mucosa in the animal model. Method. Ten Wistar albino rats were used. The fibrin glue used for the present study was a fibrinogen-based compound with double sealant components. Ten rats were anaesthetized with ketamine HCl, then the fibrin glue was applied in the left maxillary sinus, and sterile saline solution was injected in the right maxillary sinus. On postoperative day 21, the animals were euthanatized and maxillary sinus mucosa was resected for histopathological examination. Fibroblast proliferation, vascular proliferation, fibrosis, and inflammatory cell infiltration were scored from zero to three and the ratios of edema and necrosis were reported. Results. There were no significant differences in fibroblast proliferation, vascular proliferation, fibrosis, and inflammatory cell infiltration scores and the ratios of edema and necrosis between the saline and fibrin glue groups. Conclusions. Our findings support the use of fibrin glue for sinus surgery. But the surgeon should be aware of the fact that it has a potential to cause inflammatory changes. Keywords: Fibrin glue, maxillary sinus mucosa, histopathological findings, animal model, surgical material. Özet Giriş. İntranazal cerrahilerde fibrin glue doku yapıştırıcısı ve lokal hemostatik ajan ve doku yenilenmesini mekanik olarak hızlandıran bir ajan olarak kullanılmaktadır. Fibrin glue’nun biyouyumluğu genellikle yüksek olarak kabul edilir ve doku yüzeyleri için yapışkan olmakla birlikte yapışkan gücü çok düşüktür. Bu çalışmada fibrin glue’nun maksiller sinüs mukozası üzerindeki histopatolojik etkisinin rat modelinde gösterilmesi amaçlanmıştır. Yöntem. Bu çalışmada 10 Wistar albino rat kullanılmıştır. Fibrin glue bu çalışmada bir fibrinojen tabanlı çift bileşenli dolgu materyali olarak kullanıldı. Ratlara ketamin HCl ile genel anestezi uygulandıktan sonra sol maksiller sinüslerine fibrine glue ve sağ maksiller sinüslerine steril salin solusyonu enjekte edildi. Postoperatif 21. günde ratlara ötenazi uygulandıktan sonra maksiller sinüs mukozası histopatolojik inceleme için cerrahi olarak çıkartıldı. Fibroblast profilerasyonu, fibrozis, vasküler proliferasyon ve inflamatuar hücre infiltrasyonu 0-3 arasında skorlanırken ödem ve nekrozis yüzde olarak tespit edildi. Bulgular. Fibrin glue ve saline uygulanan iki grup arasında fibroblast proliferasyonu, vasküler proliferasyon, fibrozis ve enflamatuvar hücre infiltrasyonu skorları ve ödem ve nekrozis oranları arasında istatistiksel olarak anlamlı bir fark saptanmadı. Sonuçlar. Elde ettiğimiz bulgular maksiller sinüs cerrahinde fibrine glue’nun güvenli bir şekilde kullanılabileceğini desteklemekle birlikte bu maddenin mukozal yüzeylerde inflamatuar değişikliklere neden olan bir potansiyelinin olabildiğini hekimlerin daima akılda tutması gerektiği kanısındayız. Anahtar sözcükler: Fibrin glue, maksiller sinüs mukozası, histopatolojik bulgular, hayvan deneyleri, cerrahi materyal 339 Geliş tarihi/Received: May 6, 2011; Kabul tarihi/Accepted: August 3, 2011 *Corresponding author: Elif Emine Altuntaş, MD., Kulak Burun Boğaz Anabilim Dalı, Cumhuriyet Üniversitesi Tıp Fakültesi, TR-58140 Sivas. E-mail: Introduction The human body is able to repair soft and hard tissue wounds in many cases. Often this repairing procedure is achieved by mechanical fastening of tissues by sutures or staples methods. The basic technique of suturing is difficult for sinus mucosa perforations because of limited access to and friability of the membrane, therefore liquid tissue adhesives are used for the repair of perforations. Three tissue adhesives are most frequently used: cyanoacrylates, gelatin resorcinol and fibrin-based glues. Gelatin resorcinol and cyanoacrylates are known to have cytotoxic effects; on the other hand, the fibrin glues, are generally considered highly biocompatible and adhesive to tissue surfaces but have very low cohesive strength [1]. Iatrogenic injuries during functional endoscopic sinus surgery (FESS) are more frequently seen in anterior ethmoid region that is directly neighboring the lamina cribrosa. Lamina cribrosa are very fragile. Bony defects or dehiscences can occur in other regions, such as the tectal insertion of the middle turbinate, the canals of the anterior and posterior ethmoidal artery. When these iatrogenic injuries lead to the cerebrospinal fluid (CSF) leak; a lot of techniques and materials such as a muscle, fascias (lata, temporalis), bone wax, bony pate, mucochondral flaps, dural flaps, tissue adhesives, and fat can be used for closure of fistulas [1-3]. The aim of this study was to assess the histopathological effects of fibrin glue in maxillary sinus mucosa and to compare the results by using sterile saline solution which is known as non cytotoxic material in rat model. Material and methods Animals The experimental procedures were approved by the Animal Ethics Committee of Cumhuriyet University, and the study was conducted following accepted guidelines for the care and use of laboratory animals for research. Ten Wistar albino rats (Cumhuriyet University Animal Laboratory, Sivas, Turkey), weighing 200-250 g were used. All the animals were fed by a standard laboratory diet and drinking water was available ad libitum during the experiment. They were kept in a room where the temperature (22°C ± 2°C), humidity (50%-70%), and 12-h day-night cycle were controlled. All rats were observed for several days to ascertain health before operations and controlled for their microbiological status. Fibrin glue The fibrin glue used for the present study was a fibrinogen-based compound with double sealant components (Beriplast ® P Combi- Set, Behring GmbH AG, Marburg, Germany). The 3 mL Beriplast ® P set contains: Vial 1: Fibrinogen concentrate consisting of 270 mg dry substance, containing human plasma protein fraction with a factor XIII activity of 180 U. Vial 2: Aprotinin solution consisting of 3 mL solution containing 3000 KIU of bovine lung aprotinin. Vial 3: Thrombin c (...truncated)