title: Immunohistochemical studies of wound healing after monopolar electrocautery and ultrasound submucosal inferior nasal turbinate reduction in sheep.
abstract: BACKGROUND
  Extracellular matrix (ECM) proteins such as fibronectin and collagen III, enzymes such as matrix metalloproteinases and macrophages have been demonstrated to intervene in nasal and paranasal sinuses wound healing.
  
  
  OBJECTIVE
  To compare concentration of ECM proteins, enzymes and the recruitment of macrophages during wound repair after monopolar electrocautery in contrast with ultrasound submucosal surgical tissue reduction of inferior nasal turbinate (INT) tested in sheep.
  
  
  METHODS
  Prospective controlled study in sheep. Immunostaining for collagen III, fibronectin, CD68 and matrix metalloproteinase-9 (MMP9) was applied in tissue specimens of INT mucosa after monopolar electrocoagulation (MEC) and ultrasound tissue reduction (UTR). Twelve INTs were studied 1, 3 and 8 weeks post-operatively in each interventional group (MEC and UTR) and 5 INTs were studied in animals of the control group (without surgery). The immunoreactivity was quantitatively graded between 0% to 100% immunoreactivity by a blinded senior pathologist.
  
  
  RESULTS
  At the end of the study period collagen III, fibronectin and MMP9 were increased in both groups compared to the levels of the control group. When compared to control group, CD68 immunoreactivity was found higher in MEC group but not in UTR group. Fibronectin subepithelial immunoreactivity exhibited a substantial negative correlation with mucosal epithelial cell necrosis, a substantial positive correlation with fibrosis in MEC-treated specimens and a significant positive correlation with sinusoid engorgement in UTR-treated specimens. Collagen III tissue immunoreactivity showed a particularly significant negative correlation with sinusoid engorgement in MEC-treated specimens.
  
  
  CONCLUSIONS
  Correlation of fibronectin and collagen III immunoreactivity to histopathologic findings suggests different ECM repair processes between MEC and UTR turbinate tissue reduction. The use of CD68 and MMP9 provides additional clues to the mode of actions of these techniques and to the molecular and cellular events of the nasal mucosa wound healing process.
authors.affiliation: Department of Otorhinolaryngology, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: C S
authors.initials: CS
authors.lastname: Nousia
authors.forename: H
authors.initials: H
authors.lastname: Gouveris
authors.forename: A
authors.initials: A
authors.lastname: Giatromanolaki
authors.forename: M
authors.initials: M
authors.lastname: Katotomichelakis
authors.forename: P
authors.initials: P
authors.lastname: Ypsilantis
authors.forename: M
authors.initials: M
authors.lastname: Riga
authors.forename: E
authors.initials: E
authors.lastname: Sivridis
authors.forename: J B
authors.initials: JB
authors.lastname: Watelet
authors.forename: P
authors.initials: P
authors.lastname: van Cauwenberge
authors.forename: V
authors.initials: V
authors.lastname: Danielides
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D015703:Antigens, CD / Q000378:metabolism; D015214:Antigens, Differentiation, Myelomonocytic / Q000378:metabolism; D003094:Collagen / Q000378:metabolism; D004564:Electrocoagulation; D005260:Female; D005353:Fibronectins / Q000378:metabolism; D007124:Immunoenzyme Techniques / Q000379:methods*; D020780:Matrix Metalloproteinase 9 / Q000378:metabolism; D009297:Nasal Mucosa / Q000378:metabolism / Q000601:surgery*; D011446:Prospective Studies; D034561:Sheep, Domestic; D018709:Statistics, Nonparametric; D014420:Turbinates / Q000378:metabolism / Q000601:surgery*; D014464:Ultrasonic Therapy; D014945:Wound Healing / Q000502:physiology*; D000097382:CD68 Molecule
chemical_list: D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D003094:Collagen; D005353:Fibronectins; D020780:Matrix Metalloproteinase 9; C067980:CD68 antigen, human; D000097382:CD68 Molecule