Effectiveness of MESNA on the success of cholesteatoma surgery

Kalcıoğlu, M. Tayyar; Çiçek, Mehmet; Bayındır, Tuba; Özdamar, Özkan

doi:10.1016/j.amjoto.2014.01.002

Cited by 21 publications

(34 citation statements)

References 16 publications

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“…Previous studies have reported that the use of MESNA in atelectatic and adhesive middle ear and cholesteatoma surgery is not associated with ototoxic effects and had neuroprotective effects; however, to the best of our knowledge, its direct effect on the facial nerve has not been demonstrated [7][8][9][10]12] . The possibility of dehiscence development in the fallopian canal of the facial nerve is very high in the presence of pathologies progressing with dissolving bone structures, such as cholesteatoma; the use of MESNA for separating the cholesteatoma matrix in such surgeries inevitably results in contact with the facial nerve, directly or by passing through bony dehiscence.…”

Section: Introductionmentioning

confidence: 79%

“…The facial nerve in the parotid region of the rats was preferred because it is easy to reach and has the same characteristics as the facial nerve in the middle ear. As observed in previous studies on MESNA, a single dose of solutions diluted using physiological saline at concentrations of 20% and 50% was tested on separate groups [7,8,10,12] . The wavelength, latency, amplitude, and supramaximal stimuli thresholds, as measured by EMG, were recorded and statistically evaluated within each group as well as between all groups.…”

Section: Discussionmentioning

confidence: 99%

“…In the field of otology, MESNA is used to easily dissect the tissue layers during ear surgeries, such as atelectatic ear and cholesteatoma, and its use has increased in recent years [7] . Some animal studies have shown that MESNA has no harmful effects on the cochlea and does not cause ototoxicity [8,12] .…”

Section: Discussionmentioning

confidence: 99%

“…Although new techniques and surgical procedures have been introduced, the incidence of residual cholesteatoma was reported to vary from 5% to 50% [7] . The cholesteatoma matrix is mainly covered with keratin, and it contains numerous disulfide bonds.…”

Section: Introductionmentioning

confidence: 99%

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Electrophysiological and Histopathological Evaluation of Effects of Sodium-2 Mercaptoethanesulfonate Used for Middle Ear Surgery on Facial Nerve Functions

et al. 2018

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OBJECTIVE: Sodium-2-mercaptoethanesulfonate (MESNA) is widely used in medicine because of its antioxidant and mucolytic effects. In recent years, it has been used in otologic surgery. Because it cleaves disulfide bonds, it is used to easily dissect the epithelial matrix in cholesteatoma and atelectasis. In this study, we hypothesized that MESNA does not have any toxic effect on the facial nerve, and the effects of MESNA on the facial nerve were examined histologically and electrophysiologically. MATERIALS and METHODS:Twenty Wistar albino rats were used. Groups A and B were designated as the control and sham groups, respectively. The animals in groups C and D were administered 20% and 50% of MESNA solution, respectively, after the facial nerve was exposed in the parotid region. Electromyography (EMG) measurements were performed preoperatively and postoperatively at 4 weeks. The animals were subsequently euthanized; facial nerve samples were taken for histopathological examination. RESULTS:When EMG parameters were compared within and between each group, preoperative and postoperative results were not statistically significantly different. Histopathological examination showed that MESNA did not cause any inflammation, granulation tissue, or foreign body reaction. CONCLUSION:To the best of our knowledge, the effects of MESNA on facial nerve functions have not been investigated. In this study, the effects of MESNA after direct application to the facial nerve were examined electrophysiologically and histologically, and it was determined that MESNA did not cause any toxic effects. It was concluded that MESNA can, therefore, be safely used during middle ear surgery.

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Section: Introductionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Electrophysiological and Histopathological Evaluation of Effects of Sodium-2 Mercaptoethanesulfonate Used for Middle Ear Surgery on Facial Nerve Functions

et al. 2018

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“…Yilmaz et al [10] reported that MESNA was successful in atelectatic ears and adhesive otitis media because it made the operation easier and safer by allowing elevation of the tympanic membrane through its mechanical and chemical actions. Kalcioglu et al [14] investigated the use of 20% MESNA in chronic otitis with cholesteatoma and reported that it could be helpful for eliminating the disease and increasing surgical success. In that study, residual cholesteatoma rates were significantly higher when MESNA was not applied.…”

Section: Discussionmentioning

confidence: 99%

The Effects of MESNA on the Facial Nerve, an Experimental Animal Study

Baklacı¹,

Kum

Kulaçoğlu

et al. 2018

Int Adv Otol

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OBJECTIVE: MESNA (Sodium-2-mercaptoethanesulfonate) is a mucolytic substance that is used for chemically assisted tissue dissection in various surgical operations. The aim of this study was to address the issue of possible neurotoxicity from topical administration of MESNA solution on the facial nerve. We used different concentrations of MESNA solution and evaluated their effects on facial nerve by histopathological and functional analysis. MATERIALS and METHODS:These groups were the saline administered group (control) (3 rats, 6 facial nerves), the 25% MESNA solution group (3 rats, 6 facial nerves), and the 100% MESNA solution group (3 rats, 6 facial nerves). Under general anesthesia (ketamine 150 mg/kg, xylocaine 4 mg/kg), the bilateral facial nerves of rats were dissected. The saline, 25% MESNA, and 100% MESNA solutions. Facial nerve functions of the rats were evaluated using mustachewhisker and blink reflex scores at day 20 days. On day 20, the rats were sacrificed and the buccal and marginal mandibular branches of the facial nerve were removed. The specimens were examined in terms of inflammation, granulation tissue, and foreign body reaction formation around the nerve. The functional and histopathological changes on facial nerves were compared between groups. RESULTS:Mustache and blink reflex scores of the rats were 5 (normal) in both the control and study groups. There were no statistically significant differences between the three groups in terms of facial nerve functions (p=1.00). On histopathologic examination, the 25% and 100% MESNA groups had significantly more inflammation compared with the control group (p=0.038 and p=0.007, respectively). There were no statistically significant differences between the 25% and 100% MESNA groups in term of inflammation (p>0.05). There were no statistically significant differences between the three groups in terms of foreign body reaction formation (p>0.05). CONCLUSION:Topical administration of MESNA solution onto the facial nerve causes increased inflammation in both the 25% and 100% concentrations. Nevertheless, it does not cause any facial nerve dysfunction.

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Identifying epithelial borders in cholesteatoma surgery using narrow band imaging

Baazil

Eggink

Wolf

et al. 2021

Eur Arch Otorhinolaryngol

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Purpose To quantify changes in the perceived epithelial border with narrow band imaging (NBI) and white light imaging (WLI) during cholesteatoma surgery and to objectify possible benefits of NBI in otology. Methods Perioperative digital endoscopic images were captured during combined approach tympanoplasty at our tertiary referral center using WLI and NBI (415 nm and 540 nm wavelengths). Sixteen otologic surgeon defined the epithelial borders within 16 identical WLI and NBI photos. Pixels of these selections were calculated to analyze the quantitative difference between WLI and NBI. A questionnaire also analyzed the qualitative differences. Results Sixteen otologic surgeons participated in the study. Stratified per photo, only two photos yielded a significant difference: less pixels were selected with NBI than WLI. A Bland–Altman plot showed no systemic error. Stratified per otologist, four participants selected significantly more pixels with WLI than with NBI. Overall, no significant difference between selected pixels was found. Sub-analyses of surgeons with more than 5 years of experience yielded no additional findings. Despite these results, 60% believed NBI could be advantageous in defining epithelial borders, of which 83% believed NBI could reduce the risk of residual disease. Conclusion There was no objective difference in the identification of epithelial borders with NBI compared to WLI in cholesteatoma surgery. Therefore, we do not expect the use of NBI to evidently decrease the risk of residual cholesteatoma. However, subjective assessment does suggest a possible benefit of lighting techniques in otology. Level of evidence 3.

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Effectiveness of MESNA on the success of cholesteatoma surgery

Cited by 21 publications

References 16 publications

Electrophysiological and Histopathological Evaluation of Effects of Sodium-2 Mercaptoethanesulfonate Used for Middle Ear Surgery on Facial Nerve Functions

Electrophysiological and Histopathological Evaluation of Effects of Sodium-2 Mercaptoethanesulfonate Used for Middle Ear Surgery on Facial Nerve Functions

The Effects of MESNA on the Facial Nerve, an Experimental Animal Study

Identifying epithelial borders in cholesteatoma surgery using narrow band imaging

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