Article Type

Original Study


Objective The aim of the present study was to assess fibroproliferative healing after endoscopic sinus surgery (ESS) by endoscopic, histopathological, and immunohistochemical (IHC) examination. The secondary objectives were to assess the correlation between fibroproliferative tissue formation and the evaluated clinical parameters. Background Fibrous tissue formation is an inevitable process during wound healing after ESS that results in the formation of sinus adhesions and synechia and is reflected on patient«SQ»s comfort and recovery from sinus diseases. Materials and methods Twenty chronic rhinosinusitis patients (12 with and eight without nasal polyposis) subjected to ESS were enrolled in the study. Patients were subjected to computed tomography and preoperative endoscopic staging of sinus disease. Patients were assessed at 2, 4, and 12 weeks postoperatively through endoscopic and tissue (histopathological and IHC) evaluation. Results There is a significant increase in the degree of fibroproliferation along the three visits in the form of fibroblast and myofibroblast proliferation (H&E stain) (P = 0.001 and P < 0.001, respectively) and presence of collagen fibers (using Masson Trichrome stain) (P = 0.008), and there was a significant increase in the ͍-smooth muscle IHC score (P < 0.001). There were no associated increases in the rate of middle meatal synechia formation or middle meatal antrostomy closure during the three follow-up periods (P > 0.05). Conclusion Wound healing after functional ESS along 12 weeks is associated with microscopic fibroproliferative healing, not apparent at macroscopic levels, and is proportional to preoperative computed tomography and endoscopic and operative technique staging.