General Medical Information

Mucosal Wound Healing

David J. Terris

Most comparisons of the healing of wounds created by various surgical instruments (knife, electrocautery, laser) have been carried out on skin in porcine models. The popularity of laser-assisted oral cavity and oropharyngeal procedures, including laser-assisted uvulopalatoplasty, has led authors to investigate the healing of mucosal wounds. There appears to be no disadvantage in wound healing when comparing laser to more conventional techniques, allowing the practitioner to make a choice of instruments based on cost, availability, ease of use, and hemostasis instead of healing properties.

When poor mucosal healing after major head and neck surgery results in a wound dehiscence, a mucocutaneous fistula may result. Although the causes of fistulae are debated (including technical factors, localized infection, prior irradiation, and poor nutrition), it is widely accepted that continued presence of infection and salivary spillage may combine to delay closure. The use of systemic antibiotics is usually advocated. There is anecdotal evidence of improvement in healing when antisialogogues (like glycopyrrolate) are used to diminish the salivary flow, but a mechanical alternative such as a salivary bypass tube or gauze packing may provide the same benefit.