The Role of Apoptosis at the Compensatory Turbinate Hypertrophy Secondary to Nasal Septum Deviation: A Case Control Study

Year 2021, Volume: 4 Issue: 1, 1 - 6, 01.04.2021

Onur Ergün Taner Yılmaz , Ayşegül Süzer , Sevda Fatma Müftüoğlu

Abstract

Objective: The concept of compensatory turbinate hypertrophy (CTH) has found a frequent mention in research works. However, despite its clinical significance, there is a paucity in the research of regulatory mechanisms of CTH process at the cellular levels. The objective of this study is to assess the importance of apoptosis in the CTH process and understand nasal physiology.

Material and Methods: In total, 23 adults who underwent septoplasty and partial turbinectomy for the management of unilateral nasal septal deviations (NSD) and CTH were included in this study. Turbinectomy specimens were immunohistochemically evaluated using terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) stain and anti-human-activated pro-Caspase 3 monoclonal antibody stains. Percentages of apoptotic cells (apoptotic index [AI]) were determined at various cell types. The statistical analysis was based on the AI differences between the hypertrophic and non-hypertrophic turbinates of the same patient. A subgroup analysis was also performed to evaluate the effect of smoking on AIs.

Results: No cell type had statistically significant AI differences between the hypertrophic and non-hypertrophic turbinates. Vascular smooth muscle cells of the CTH side had slightly lower AIs although this trend was statistically not significant (Caspase 3, p = 0.066). No difference in AIs was detected at the other cell types. Similarly, no AI difference related to smoking could be observed.

Conclusions: Our results have not shown any significant differences among AIs of many cell types between opposite turbinates or between smokers and nonsmokers. Therefore, apoptosis has not found to be active as a mechanism of regulation for the CTH of adults with stable NSDs.

Keywords

Apoptosis , septoplasty , turbinate hypertrophy , tobacco

References

• Han JK, Stringer SP, Rosenfeld RM, et al. Clinical consensus statement: Septoplasty with or without ınferior turbinate reduction. Otolaryngol Head Neck Surg 2015; 153: 708-20.
• Grutzenmacher S, Robinson DM, Grafe K, Lang C, Mlynski G. First findings concerning airflow in noses with septal deviation and compensatory turbinate hypertrophy- A model study. ORL J Otorhinolaryngol Relat Spec 2006; 68: 199-205.
• Mladina R, Cujic E, Subaric M, Vukovic K. Nasal septal deformities in ear, nose, and throat patients: An international study. Am J Otolaryngol 2008; 29: 75-82.
• Rohrich RJ, McKee D, Malafa M. Closed microfracture technique for surgical correction of ınferior turbinate hypertrophy in rhinoplasty: Safety and technical considerations. Plast Reconstr Surg 2015; 136: 607e-11e.
• Romano A, Orabona GD, Salzano G, Abbate V, Iaconetta G, Califano L. Comparative study between partial inferior turbinotomy and microdebrider-assisted inferior turbinoplasty. J Craniofac Surg 2015; 26 :e235-8.
• Kerr JF, Wyllie AH, Currie AR. Apoptosis: A basic biological phenomenon with wide-ranging implications in tissue kinetics. Br J Cancer 1972; 26: 239-57.
• Huerta S, Goulet EJ, Huerta-Yepez S, Livingston EH. Screening and detection of apoptosis. J Surg Res 2007; 139: 143-56.
• Weissman-Shomer P, Fry M. Chick embryo fibroblasts senscence in vitro: Pattern of cell division and life span as a function of cell density. Mech Ageing Dev 1975; 4: 159-66.
• Bursch W, Paffe S, Putz B, Barthel G, Schulte-Hermann R. Determination of the length of the histological stages of apoptosis in normal liver and in altered hepatic foci of rats. Carcinogenesis 1990; 11: 847-53.
• Garrity MM, Burgart LJ, Riehle DL, Hill EM, Sebo TJ, Witzig T. Identifying and quantifying apoptosis: Navigating technical pitfalls. Mod Pathol 2003; 16: 389-94.
• Cakabay T, Sayin I, Erdur O, Muhammedoglu A, Tekke NS, Kayhan FT. Role of apoptosis in the pathogenesis of nasal polyps based upon Galectin-3 expression. J Craniofac Surg 2017; 28: 280-4.
• Onal M, Yilmaz T, Bilgic E, Muftuoglu S, Sozen T, Bajin MD. Possible role of apoptosis in pathogenesis of adenoid hypertrophy and chronic adenoiditis: Prospective case-control study. Auris Nasus Larynx 2015; 42: 449-52.
• Onal M, Yilmaz T, Bilgic E, Muftuoglu SF, Kuscu O, Gunaydin RO. Apoptosis in chronic tonsillitis and tonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 2015; 79: 191-5.
• Shirasaki H, Watanabe K, Kanaizumi E, et al. Analysis of apoptotic cells in allergic and non-allergic nasal mucosa. Allergology International 2001; 50: 311-7.
• Camacho M, Zaghi S, Certal V, Abdullatif J, Means C, Acevedo J, et al. Inferior turbinate classification system, grades 1 to 4: Development and validation study. Laryngoscope 2015;125: 296-302.
• Sozen T, Yilmaz T, Tezel YGG. Nazal septum deviasyonunda görülen alt konka hipertrofisi patogenezinin, vasküler endotelial growth faktör, epidermal growth faktör, bazik fibroblast growth faktör, bone morfojenik protein-2 ve nerve growth faktör ile incelenmesi [Thesis]. H.U. Tıp Fakültesi, Doktora Tezi. Ankara. 2011.
• Kamani T, Yilmaz T, Surucu S, Bajin MD, Gunaydin RO, Kuscu O. Histopathological changes in nasal mucosa with nasal septum deviation. Eur Arch Otorhinolaryngol 2014; 271: 2969-74.
• Berger G, Hammel I, Berger R, Avraham S, Ophir D. Histopathology of the inferior turbinate with compensatory hypertrophy in patients with deviated nasal septum. Laryngoscope 2000; 110: 2100-5.
• Kim DH, Park HY, Kim HS, et al. Effect of septoplasty on inferior turbinate hypertrophy. Arch Otolaryngol Head Neck Surg 2008; 134: 419-23.
• Labat-Moleur F, Guillermet C, Lorimier P, et al. TUNEL apoptotic cell detection in tissue sections: Critical evaluation and improvement. J Histochem Cytochem 1998; 46: 327-34.
• Krijnen PA, Nijmeijer R, Meijer CJ, Visser CA, Hack CE, Niessen HW. Apoptosis in myocardial ischaemia and infarction. J Clin Pathol 2002; 55: 801-11.
• D'Agostini F, Balansky RM, Izzotti A, Lubet RA, Kelloff GJ, De Flora S. Modulation of apoptosis by cigarette smoke and cancer chemopreventive agents in the respiratory tract of rats. Carcinogenesis 2001; 22: 375-80.
• Imirzalioglu P, Uckan S, Alaaddinoglu EE, Haberal A, Uckan D. Cigarette smoking and apoptosis. J Periodontol 2005; 76: 737-9.