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Clinical Efficacy of a Spray Containing Hyaluronic Acid and Dexpanthenol after Surgery in the Nasal Cavity (Septoplasty, Simple Ethmoid Sinus Surgery, and Turbinate Surgery)

DOI: 10.1155/2014/635490

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Abstract:

Background. This prospective, controlled, parallel-group observational study investigated the efficacy of a spray containing hyaluronic acid and dexpanthenol to optimise regular treatment after nasal cavity surgery in 49 patients with chronic rhinosinusitis. Methods. The control group received standard therapy. Mucosal regeneration was determined using rhinoscopy sum score (RSS). Pre- and postoperative nasal patency was tested using anterior rhinomanometry. The participants were questioned about their symptoms. Results. Regarding all RSS parameters (dryness, dried nasal mucus, fibrin deposition, and obstruction), mucosal regeneration achieved good final results in both groups, tending to a better improvement through the spray application, without statistically significant differences during the whole assessment period, the mean values being 7.04, 5.00, 3.66, and 3.00 (intervention group) and 7.09, 5.14, 4.36, and 3.33 (control group). No statistically significant benefit was identified for nasal breathing, foreign body sensation, and average rhinomanometric volume flow, which improved by 12.31% (control group) and 11.24% (nasal spray group). Conclusion. The investigational product may have additional benefit on postoperative mucosal regeneration compared to standard cleaning procedures alone. However, no statistically significant advantage could be observed in this observational study. Double-blind, controlled studies with larger populations will be necessary to evaluate the efficacy of this treatment modality. 1. Introduction Ventilation, mucociliary transport, and the epithelial barrier are considerably impaired initially following surgical procedures of the nasal cavity. Injury of the nasal mucosa involved not only with the procedure but also prior to surgery caused by various pathologies usually results in the reduction of the protective secretion film and damage to the highly sensitive cilia [1]. Rapid wound healing from rhinosurgical procedures therefore reduces the risk of new infections considerably. Although minimally invasive endoscopic technology and instruments enable functional endoscopic paranasal surgery that is gentle to the mucosa, the final results remain dependent upon proper wound healing of the nasal or paranasal mucosa without extreme scarring. Large-scale crusting, mucosal changes, ventilation disorders due to excessive secretion and edema, secondary hemorrhaging, or the development of synechia with possible reobstruction are critical factors that can lead to postoperative complications. Besides frequent check-ups and wound

References

[1]  T. Verse, C. Sikora, P. Rudolph, and N. Kl?cker, “Die Vertr?glichkeit von Nasalia unter besonderer Berücksichtigung des Einflusses von Konservierungsmitteln und physikalisch-chemischen Parametern,” Laryngo-Rhino-Otologie, vol. 82, no. 11, pp. 782–789, 2003.
[2]  B. P. Toole, “Hyaluronan in morphogenesis,” Seminars in Cell and Developmental Biology, vol. 12, no. 2, pp. 79–87, 2001.
[3]  Y.-H. Liao, S. A. Jones, B. Forbes, G. P. Martin, and M. B. Brown, “Hyaluronan: pharmaceutical characterization and drug delivery,” Drug Delivery, vol. 12, no. 6, pp. 327–342, 2005.
[4]  B. P. Toole, “Hyaluronan is not just a goo!,” The Journal of Clinical Investigation, vol. 106, no. 3, pp. 335–336, 2000.
[5]  R. Weber, R. Keerl, A. Huppmann, B. Schick, and W. Draf, “Der Einflu? der Nachbehandlung auf die Wundheilung nach endonasaler Nasennebenh?hlenoperation,” Laryngo-Rhino-Otologie, vol. 75, no. 4, pp. 208–214, 1996.
[6]  W. Hosemann, L. Dunker, U. G?de, and M. E. Wigand, “Experimentelle Untersuchungen zur Wundheilung in den Nasennebenh?hlen. III. Endoskopie und Histologie des Operationsgebietes nach einer endonasalen Siebbeinausr?umung,” HNO, vol. 39, pp. 111–115, 1991.
[7]  W. Y. Chen and G. Abatangelo, “Functions of hyaluronan in wound repair,” Wound Repair and Regeneration, vol. 7, no. 2, pp. 79–89, 1999.
[8]  J. A. Iocono, H. P. Ehrlich, K. A. Keefer, and T. M. Krummel, “Hyaluronan induces scarless repair in mouse limb organ culture,” Journal of Pediatric Surgery, vol. 33, no. 4, pp. 564–567, 1998.
[9]  P. Samuels and A. K. Tan, “Fetal scarless wound healing,” The Journal of Otolaryngology, vol. 28, no. 5, pp. 296–302, 1999.
[10]  R. Stern and H. I. Maibach, “Hyaluronan in skin: aspects of aging and its pharmacologic modulation,” Clinics in Dermatology, vol. 26, no. 2, pp. 106–122, 2008.
[11]  P. W. Noble, “Hyaluronan and its catabolic products in tissue injury and repair,” Matrix Biology, vol. 21, no. 1, pp. 25–29, 2002.
[12]  R. Krasinski and H. Tchorzewski, “Hyaluronan-mediated regulation of inflammation,” Post?py Higieny i Medycyny Do?wiadczalnej, vol. 61, pp. 683–689, 2007.
[13]  M. Prosdocimi and C. Bevilacqua, “Exogenous hyaluronic acid and wound healing: an updated vision,” Panminerva Medica, vol. 54, no. 2, pp. 129–135, 2012.
[14]  A. Ludwig, “The use of mucoadhesive polymers in ocular drug delivery,” Advanced Drug Delivery Reviews, vol. 57, no. 11, pp. 1595–1639, 2005.
[15]  M. F. Saettone, D. Monti, M. T. Torracca, and P. Chetoni, “Mucoadhesive ophthalmic vehicles: evaluation of polymeric low-viscosity formulations,” Journal of Ocular Pharmacology, vol. 10, no. 1, pp. 83–92, 1994.
[16]  R. J. Rohrich, A. Ghavami, and M. A. Crosby, “The role of hyaluronic acid fillers (Restylane) in facial cosmetic surgery: review and technical considerations,” Plastic and Reconstructive Surgery, vol. 120, no. 6, 2007.
[17]  K. L. Beasley, M. A. Weiss, and R. A. Weiss, “Hyaluronic acid fillers: a comprehensive review,” Facial Plastic Surgery, vol. 25, no. 2, pp. 86–94, 2009.
[18]  T. Y. Han, J.W. Lee, J. H. Lee et al., “Subdermal minimal surgery with hyaluronic acid as an effective treatment for neck wrinkles,” Dermatologic Surgery, vol. 37, no. 9, pp. 1291–1296, 2011.
[19]  C. Muhn, N. Rosen, N. Solish et al., “The evolving role of hyaluronic acid fillers for facial volume restoration and contouring: a Canadian overview,” Clinical, Cosmetic and Investigational Dermatology, vol. 5, pp. 147–158, 2012.
[20]  V. S. Lambros, “Hyaluronic acid injections for correction of the tear trough deformity,” Plastic and Reconstructive Surgery, vol. 120, no. 6, pp. 74S–80S, 2007.
[21]  S. Nanda and S. Bansal, “Upper face rejuvenation using botulinum toxin and hyaluronic acid fillers,” Indian Journal of Dermatology, Venereology and Leprology, vol. 79, no. 1, pp. 32–40, 2013.
[22]  A. Redaelli, “Medical rhinoplasty with hyaluronic acid and botulinum toxin A: a very simple and quite effective technique,” Journal of Cosmetic Dermatology, vol. 7, no. 3, pp. 210–220, 2008.
[23]  K. P. Vercruysse and G. D. Prestwich, “Hyaluronate derivatives in drug delivery,” Critical Reviews in Therapeutic Drug Carrier Systems, vol. 15, no. 5, pp. 513–555, 1998.
[24]  K. Morimoto, H. Yamaguchi, Y. Iwakura, K. Morisaka, Y. Ohashi, and Y. Nakai, “Effects of viscous hyaluronate-sodium solutions on the nasal absorption of vasopressin and an analogue,” Pharmaceutical Research, vol. 8, no. 4, pp. 471–474, 1991.
[25]  Türker S., E. Onur, and Y. Ozer, “Nasal route and drug delivery systems,” Pharmacy World and Science, vol. 26, no. 3, pp. 137–142, 2004.
[26]  M. I. Ugwoke, R. U. Agu, N. Verbeke, and R. Kinget, “Nasal mucoadhesive drug delivery: background, applications, trends and future perspectives,” Advanced Drug Delivery Reviews, vol. 57, no. 11, pp. 1640–1665, 2005.
[27]  Y. Huh, H. Cho, I. Yoon et al., “Preparation and evaluation of spray-dried hyaluronic acid microspheres for intranasal delivery of fexofenadine hydrochloride,” European Journal of Pharmaceutical Sciences, vol. 40, no. 1, pp. 9–15, 2010.
[28]  K. Y. Cho, T. W. Chung, B. C. Kim et al., “Release of ciprofloxacin from poloxamer-graft-hyaluronic acid hydrogels in vitro,” International Journal of Pharmaceutics, vol. 260, no. 1, pp. 83–91, 2003.
[29]  S. T. Lim, G. P. Martin, D. J. Berry, and M. B. Brown, “Preparation and evaluation of the in vitro drug release properties and mucoadhesion of novel microspheres of hyaluronic acid and chitosan,” Journal of Controlled Release, vol. 66, no. 2-3, pp. 281–292, 2000.
[30]  H. Wolburg, K. Wolburg-Buchholz, H. Sam, S. Horvát, M. A. Deli, and A. F. Mack, “Epithelial and endothelial barriers in the olfactory region of the nasal cavity of the rat,” Histochemistry and Cell Biology, vol. 130, no. 1, pp. 127–140, 2008.
[31]  C. M. Lehr, “Lectin-mediated drug delivery: the second generation of bioadhesives,” Journal of Controlled Release, vol. 65, no. 1-2, pp. 19–29, 2000.
[32]  S. Horvát, A. Fehér, H. Wolburg, et al., “Sodium hyaluronate as a mucoadhesive component in nasal formulation enhances delivery of molecules to brain tissue,” European Journal of Pharmaceutics and Biopharmaceutics, vol. 72, no. 1, pp. 252–259, 2009.
[33]  J. Aigner, J. Tegeler, P. Hutzler, et al., “Cartilage tissue engineering with novel nonwoven structured biomaterial based on hyaluronic acid benzyl ester,” Journal of Biomedical Materials Research, vol. 42, no. 2, pp. 172–181, 1998.
[34]  T.-W. Huang, Cheng P. W., Y. H. Chan, T. H. Yeh, Y. H. Young, and T. H. Young, “Regulation of ciliary differentiation of human respiratory epithelial cells by the receptor for hyaluronan-mediated motility on hyaluronan-based biomaterials,” Biomaterials, vol. 31, no. 26, pp. 6701–6709, 2010.
[35]  E. A. Balazs, “Hyaluronan as an ophthalmic viscoelastic device,” Current Pharmaceutical Biotechnology, vol. 9, no. 4, pp. 236–238, 2008.
[36]  C. Schramm, M. S. Spitzer, S. Henke-Fahle, et al., “The cross-linked biopolymer hyaluronic acid as an artificial vitreous substitute,” Investigative Ophthalmology and Visual Science, vol. 53, no. 2, pp. 613–621, 2012.
[37]  K. Takeuchi, M. Nakazawa, T. Metoki, H. Yamazaki, Y. Miyagawa, and T. Ito, “Effects of solid hyaluronic acid film on postoperative fibrous scar formation after strabismus surgery in animals,” Journal of Pediatric Ophthalmology and Strabismus, vol. 48, no. 5, pp. 301–304, 2011.
[38]  K. Takeuchi, M. Nakazawa, H. Yamazaki et al., “Solid hyaluronic acid film and the prevention of postoperative fibrous scar formation in experimental animal eyes,” Archives of Ophthalmology, vol. 127, no. 4, pp. 460–466, 2009.
[39]  P. I. Condon, C. G. McEwen, M. Wright, G. Mackintosh, R. J. Prescott, and C. McDonald, “Double blind, randomised, placebo controlled, crossover, multicentre study to determine the efficacy of a 0.1% (w/v) sodium hyaluronate solution (Fermavisc) in the treatment of dry eye syndrome,” The British Journal of Ophthalmology, vol. 83, no. 10, pp. 1121–1124, 1999.
[40]  C. C. McDonald, S. B. Kaye, F. C. Figueiredo, G. Macintosh, and C. Lockett, “A randomised, crossover, multicentre study to compare the performance of 0.1% (w/v) sodium hyaluronate with 1.4% (w/v) polyvinyl alcohol in the alleviation of symptoms associated with dry eye syndrome,” Eye, vol. 16, no. 5, pp. 601–607, 2002.
[41]  P. Aragona, G. Di Stefano, F. Ferreri, R. Spinella, and A. Stilo, “Sodium hyaluronate eye drops of different osmolarity for the treatment of dry eye in Sj?gren’s syndrome patients,” British Journal of Ophthalmology, vol. 86, no. 8, pp. 879–884, 2002.
[42]  M. Berlucchi, P. Castelnuovo, A. Vincenzi, B. Morra, and E. Pasquini, “Endoscopic outcomes of resorbable nasal packing after functional endoscopic sinus surgery: a multicenter prospective randomized controlled study,” European Archives of Oto-Rhino-Laryngology, vol. 266, no. 6, pp. 839–845, 2009.
[43]  R. Valentine and P. Wormald, “Nasal dressings after endoscopic sinus surgery: what and why?” Current Opinion in Otolaryngology & Head and Neck Surgery, vol. 18, no. 1, pp. 44–48, 2010.
[44]  R. K. Weber and U. Hay, “Ist die Nasentamponade noch zeitgem???” Laryngo-Rhino-Otologie, vol. 82, no. 9, pp. 650–654, 2003.
[45]  B. A. Woodworth, R. K. Chandra, M. J. Hoy, F. S. Lee, R. J. Schlosser, and M. B. Gillespie, “Randomized controlled trial of hyaluronic acid/carboxymethylcellulose dressing after endoscopic sinus surgery,” ORL, vol. 72, no. 2, pp. 101–105, 2010.
[46]  K. E. Rodgers, D. B. Johns, W. Girgis, J. Campeau, and G. S. diZerega, “Reduction of adhesion formation with hyaluronic acid after peritoneal surgery in rabbits,” Fertility and Sterility, vol. 67, no. 3, pp. 553–558, 1997.
[47]  D. B. Johns, Rodgers K. E., Donahue W. D., T. C. Kiorpes, and G. S. diZerega, “Reduction of adhesion formation by postoperative administration of ionically cross-linked hyaluronic acid,” Fertility and Sterility, vol. 68, no. 1, pp. 37–42, 1997.
[48]  R. E. Leach, J. W. Burns, E. J. Dawe, M. D. Smithbarbour, and M. P. Diamond, “Reduction of postsurgical adhesion formation in the rabbit uterine horn model with use of hyaluronate/carboxymethylcellulose gel,” Fertility and Sterility, vol. 69, no. 3, pp. 415–418, 1998.
[49]  J. W. Burns, K. Skinner, M. J. Colt, L. Burgess, R. Rose, and M. P. Diamond, “A hyaluronate based gel for the prevention of postsurgical adhesions: evaluation in two animal species,” Fertility and Sterility, vol. 66, no. 5, pp. 814–821, 1996.
[50]  E. P. Goldberg, J. W. Burns, and Y. Yaacobi, “Prevention of postoperative adhesions by precoating tissues with dilute sodium hyaluronate solutions,” Progress in Clinical and Biological Research, vol. 381, pp. 191–204, 1993.
[51]  J. M. Becker, M. T. Dayton, V. W. Fazio et al., “Prevention of postoperative abdominal adhesions by a sodium hyaluronate- based bioresorbable membrane: a prospective, randomized, double-blind multicenter study,” Journal of the American College of Surgeons, vol. 183, no. 4, pp. 297–306, 1996.
[52]  G. T. Fossum, K. M. Silverberg, C. E. Miller, M. P. Diamond, and L. Holmdahl, “Gynecologic use of Sepraspray Adhesion Barrier for reduction of adhesion development after laparoscopic myomectomy: a pilot study,” Fertility and Sterility, vol. 96, no. 2, pp. 487–491, 2011.
[53]  L. S. Lohmander, N. Dalén, G. Englund et al., “Intra-articular hyaluronan injections in the treatment of osteoarthritis of the knee: a randomised, double blind, placebo controlled multicentre trial,” Annals of the Rheumatic Diseases, vol. 55, no. 7, pp. 424–431, 1996.
[54]  R. W. Jubb, S. Piva, L. Beinat, J. Dacre, and P. Gishen, “A one-year, randomised, placebo (saline) controlled clinical trial of 500–730?kDa sodium hyaluronate (Hyalgan) on the radiological change in osteoarthritis of the knee,” International Journal of Clinical Practice, vol. 57, no. 6, pp. 467–474, 2003.
[55]  J. Karlsson, L. S. Sj?gren, and L. S. Lohmander, “Comparison of two hyaluronan drugs and placebo in patients with knee osteoarthritis. A controlled, randomized, double-blind, parallel-design multicentre study,” Rheumatology, vol. 41, no. 11, pp. 1240–1248, 2002.
[56]  S. S. Leopold, B. B. Redd, W. J. Warme, P. A. Wehrle, P. D. Pettis, and S. Shott, “Corticosteroid compared with hyaluronic acid injections for the treatment of osteoarthritis of the knee. A prospective, randomized trial,” The Journal of Bone and Joint Surgery A, vol. 85, no. 7, pp. 1197–1203, 2003.
[57]  F. Ebner, A. Heller, F. Rippke, and I. Tausch, “Topical use of dexpanthenol in skin disorders,” American Journal of Clinical Dermatology, vol. 3, no. 6, pp. 427–433, 2002.
[58]  T. Verse, N. Kl?cker, F. Riedel, W. Pirsig, and M. Scheithauer, “Dexpanthenol—Nasenspray versus Nasensalbe: Prospektive, randomisierte, offene Cross-over-Studie zur mukoziliaren Clearance,” HNO, vol. 52, no. 7, pp. 611–615, 2004.
[59]  P. Tantilipikorn, P. Tunsuriyawong, P. Jareoncharsri, et al., “A randomized, prospective, double-blind study of the efficacy of dexpanthenol nasal spray on the postoperative treatment of patients with chronic rhinosinusitis after endoscopic sinus surgery,” Journal of the Medical Association of Thailand, vol. 95, no. 1, pp. 58–63, 2012.
[60]  S. Presto, A. Wehmeyer, A. Filbry, F. Rippke, and S. Bielfeldt, “Stimulation der epidermalen Regeneration durch 5% Dexpanthenol—Ergebnisse einer Placebo-kontrollierten Doppelblindstudie,” H & G, vol. 76, no. 2, pp. 114–115, 2001.
[61]  H. Eggensperger, Multiaktive Wirkstoffe für Kosmetika, 1995.
[62]  W. Gehring and M. Gloor, “Effect of topically applied dexpanthenol on epidermal barrier function and stratum corneum hydration. Results of a human in vivo study,” Arzneimittel-Forschung, vol. 50, no. 7, pp. 659–663, 2000.
[63]  N. Kl?cker, T. Verse, and P. Rudolph, “Die schleimhautprotektive Wirkung von Dexpanthenol in Nasensprays. Erste Ergebnisse zytotoxischer und zilientoxischer Versuche in vitro,” Laryngo-Rhino-Otologie, vol. 82, no. 3, pp. 177–182, 2003.
[64]  S. Hauptmann, H. Sch?fer, A. Fritz, and P. Hauptmann, “Untersuchung der wachstumsbeeinflussenden Wirkung von Wundsalben an der Zellkultur,” Der Hautarzt, vol. 43, pp. 432–435, 1992.
[65]  W. Kehrl and U. Sonnemann, “Dexpanthenol-Nasenspray als wirksames Therapieprinzip zur Behandlung der Rhinitis sicca anterior,” Laryngo-Rhino-Otologie, vol. 77, no. 9, pp. 506–512, 1998.
[66]  W. Kehrl and U. Sonnemann, “Verbesserung der Wundheilung nach Nasenoperationen durch kombinierte Anwendung von Xylometazolin und Dexpanthenol,” Laryngo-Rhino-Otologie, vol. 79, no. 3, pp. 151–154, 2000.
[67]  Monographie des BfArM, “Dexpanthenol/Panthenol und Salze der Pantothens?ure zur topischen Anwendung,” Bundesanzeiger Nr. 24 v. 05.02.1993, S. 845, 1993.
[68]  W. Hosemann, U. G?de, F. L?nger, and M. E. Wigand, “Experimentelle Untersuchungen zur Wundheilung in den Nasennebenh?hlen. II. Spontaner Wundschluss und medikament?se Effekte im standardisierten Wundmodell,” HNO, vol. 39, pp. 48–54, 1991.
[69]  W. Kehrl, U. Sonnemann, and U. Dethlefsen, “Fortschritt in der Therapie der akuten Rhinitis,” Laryngo-Rhino-Otologie, vol. 82, no. 4, pp. 266–271, 2003.
[70]  C. Skudlik, A. Schnuch, W. Uter, and H. J. Schwanitz, “Berufsbedingtes Kontaktekzem nach Anwendung einer Dexpanthenol-haltigen Salbe und überblick über die IVDK-Daten zu Dexpanthenol,” Aktuelle Dermatologie, vol. 28, no. 11, pp. 398–401, 2002.
[71]  BfArM, “Klinische Prüfungen—Fragen und Antworten zur Klinik—Anwendungsbeobachtungen,” 2013, http://www.bfarm.de/DE/Service/FAQ/_functions/Arzneimittelzulassung/klinPr/klinik/3anwendbeob/_node.html.
[72]  Gebrauchsinformation, Stand M?rz 2011, Ursapharm Arzneimittel GmbH, Saarbrücken, Germany, 2011.
[73]  D. Soldati, F. Rahm, and P. Pasche, “Mucosal wound healing after nasal surgery. A controlled clinical trial on the efficacy of hyaluronic acid containing cream,” Drugs under Experimental and Clinical Research, vol. 25, no. 6, pp. 253–261, 1999.
[74]  M. S. Maccabee, D. R. Trune, and P. H. Hwang, “Effects of topically applied biomaterials on paranasal sinus mucosal healing,” American Journal of Rhinology, vol. 17, no. 4, pp. 203–207, 2003.
[75]  M. Leung and P. H. Hwang, “Rehabilitation of surgically traumatized paranasal sinus mucosa using retinoic acid,” American Journal of Rhinology, vol. 21, no. 3, pp. 271–275, 2007.
[76]  M. S. Maccabee, D. R. Trune, and P. H. Hwang, “Paranasal sinus mucosal regeneration: the effect of topical retinoic acid,” American Journal of Rhinology, vol. 17, no. 3, pp. 133–137, 2003.
[77]  V. R. Erickson, M. Antunes, B. Chen, N. A. Cohen, and P. H. Hwang, “The effects of retinoic acid on ciliary function of regenerated sinus mucosa,” American Journal of Rhinology, vol. 22, no. 3, pp. 334–336, 2008.
[78]  I. Ercan, B. O. Cakir, M. Ozcelik, and S. Turgut, “Efficacy of Tonimer gel spray on postoperative nasal care after endonasal surgery,” ORL, vol. 69, no. 4, pp. 203–206, 2007.
[79]  S. Fooanant, S. Chaiyasate, and K. Roongrotwattanasiri, “Comparison on the efficacy of dexpanthenol in sea water and saline in postoperative endoscopic sinus surgery,” Journal of the Medical Association of Thailand, vol. 91, no. 10, pp. 1558–1563, 2008.
[80]  C. Hahn, Vergleich der Vertr?glichkeit und der Auswirkungen auf die Lebensqualit?t der Behandlungsmethode mit einem liposomalen Nasenspray gegenüber der Anwendung Dexpanthenol-haltiger Nasensalbe bzw. isotonem NaCl-Spray bei Patienten mit Rhinitis sicca, 2013.
[81]  T. Kühnel, W. Hosemann, W. Wagner, and K. Fayad, “Wie traumatisierend ist die mechanische Schleimhautpflege nach Eingriffen an den Nasennebenh?hlen?” Laryngo-Rhino-Otologie, vol. 75, no. 10, pp. 575–579, 1996.
[82]  W. Hosemann, M. E. Wigand, U. G?de, F. L?nger, and I. Dunker, “Normal wound healing of the paranasal sinuses: clinical and experimental investigations,” European Archives of Oto-Rhino-Laryngology, vol. 248, no. 7, pp. 390–394, 1991.
[83]  A. Macchi, P. Terranova, E. Digilio, and P. Castelnuovo, “Hyaluronan plus saline nasal washes in the treatment of rhino-sinusal symptoms in patients undergoing functional endoscopic sinus surgery for rhino-sinusal remodeling,” International Journal of Immunopathology and Pharmacology, vol. 26, no. 1, pp. 137–145, 2013.
[84]  A. G. Beule and W. Hosemann, “Wundheilung und postoperative Behandlung nach Nasennebenh?hlenoperationen,” HNO, vol. 57, no. 8, pp. 763–771, 2009.

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