Wound healing after paranasal sinus surgery: neutrophilic inflammation influences the outcome.

AIMS: After failure of medical treatment, functional endoscopic sinus surgery (FESS) remains the best treatment for chronic sinusitis (CS) and nasal polyposis (NP). The precise mechanisms involved in wound healing after sinus surgery remain unclear. The aim of this study was to explore systematically the different histomorphological processes and cell populations involved in the wound repair of the paranasal mucosa.

METHODS AND

RESULTS

Biopsy specimens from patients operated on for CS and NP were collected 1, 2 and 6 months after surgery and compared with baseline and control specimens. A pathologist blinded to biopsy status evaluated the haematoxylin/eosin-stained sections for oedema, fibrosis and inflammatory reaction, and the immunohistochemical preparations for epithelial replication, myofibroblasts, macrophages, neutrophils and eosinophils. Samples from NP showed significantly more oedema than those from CS. At baseline, oedema showed a significant correlation with macrophages, neutrophils and eosinophils, while fibrosis was inversely correlated with neutrophils. During healing, after a short increase at month 1, oedema decreased. Fibrosis and myofibroblasts showed an inverse relationship. Finally, during the postoperative period, both macrophages and neutrophils were increased when compared with controls.

CONCLUSIONS

The severity of the neutrophilic inflammation appears to influence the formation of fibrosis during wound repair after sinus surgery.