Surgical injury to the nasal mucosa: problems and solutions

Regardless of their complexity, all surgical interventions in the nasal cavity are accompanied by surgical trauma, which determines the outcome and prognosis of the surgical procedure. Regeneration of the nasal mucosa after surgery is a complex, multicomponent process that plays a key role in the success of operations on the nasal septum and paranasal sinuses. Any surgery within the nasal cavity inevitably damages the ciliated epithelium and suppresses mucociliary clearance, leading to edema, exudation, and desquamation, thereby creating favorable conditions for microbial growth. Restoration of the mucosa occurs through the phases of hemostasis, inflammation, proliferation, and remodeling. The epithelial repair process is influenced by the balance of growth factors (TGF-β, EGF, FGF) and metalloproteinases regulating cell proliferation and migration. Impaired healing may result in synechiae formation, scarring, or septal perforation. To ensure reparative regeneration, numerous pharmacological agents and physiotherapeutic methods have been proposed, including nasal irrigations and sprays (corticosteroid and antiseptic), preparations containing hyaluronic acid and dexpanthenol, low-level laser therapy, ultra-high-frequency therapy, phototherapy, magnetotherapy, herbal-based preparations, as well as advanced biological approaches (autologous platelet-rich plasma [PRP] and cell-based technologies). This review presents the current state of knowledge regarding nasal epithelial types, mechanisms of regeneration, the impact of rhinologic surgery, methods for stimulating healing, and clinical outcomes associated with emerging technologies.