Functional endoscopic sinus surgery (FESS) is the current standard treatment for a
variety of conditions affecting the nasal cavity and the paranasal sinuses, such as
chronic rhinosinusitis, benign and malignant tumors or cerebrospinal fluid leaks .Being
mostly a one-handed technique, FESS does not allow simultaneous use of operative
instruments and blood suction, thus endonasal bleeding control represents a challenging
issue for the operating surgeon. Such narrow and highly vascularized cavities like the
nasal fossae and paranasal spaces can be entirely filled with blood within few seconds,
especially if the mucosa is severely inflamed as a consequence of rhinosinusitis.
Bleeding is possibly the most relevant factor that could impair the quality of the
surgical field during endoscopic procedures. It has been proven that uncontrolled
bleeding during endoscopic sinus surgical procedures determines poor visualization of the
anatomical landmarks, prolongs surgical time and carries a higher rate of complications
.Several techniques to control intraoperative bleeding and improve surgical view during
sinus surgery (e.g. topical vasoconstrictors, total intravenous anesthesia, controlled
hypotension) have been described and analyzed to determine their efficacy .These types of
studies, however, are complex and prone to bias, partially because standardized and
validated methods of quantifying bleeding or grading the surgical field in endoscopic
view are lacking.
Tranexamic acid functions as the competitive antagonist at the lysine site on plasminogen
. During all surgical procedures, the tissue plasminogen activator is released due to
tissue damage during surgery, which can convert tissue plasminogen to plasmin, promote
fibrinolysis and activate the fibrinolytic system. Thus, tranexamic acid functions as an
anti-fibrinolytic agent by inhibiting the tissue plasminogen activator. It can be applied
topically or systemically with this mechanism in the coagulation cascade to reduce
intraoperative bleeding .The results of several recent studies on endoscopic sinus
surgery through topical administration of tranexamic acid are encouraging in terms of the
efficacy of tranexamic acid for intraoperative bleeding and other pathological conditions
.The purpose of this study is to analyze the efficacy of nebulized tranexamic acid and
compare it with intravenous tranexamic acid to improve the surgeon and patient
experiences of sinus surgery.
