Correlation of fibronectin distribution in chronic maxillary sinusitis with histopathological and bacteriological findings

ABSTRACT

In 40 patients their ages ranged from 18 - 40 years with clinically and radiologically proved chronic maxillary sinusitis [CMS], we investigated them for the significance of fibronectin [Fn] distribution in antral mucosa and its correlation with bacteriological and histopathological findings.We obtained bacterial growth in 60% of our series which was polymicrobial including anaerobes [41.66%] mixed [33.34%] and aerobes [25%]. Failure to obtain bacterial growth in 40% of cases does not indicate absence of the disease which may be confirmed by Fn distribution and histopathological findings. It was also confirmed that no rule could be given to the type of histological pattern in relation to specific pathogen. According to the type and amount of cellular infiltration the CMS was divided into 4 categories; plasmalymphocytic, eosinophilic, mixed and hypocellular.Also according to the course of the disease the CMS was classified into fibrotic sinusits which needs no treatment and evolutive sinusitis with acitve inflammatory reaction which may be managed depending upon the type of cellular infiltration and amount of mucosal damage.As for Fn distribution, it was proved to be found on surface epithelium, intracellular, basement membrane, periglandular, apical cell glandular, perivascular and stromal areas in different combinations. While it was present on surface epithelium in cases of gram - positive bacteria and to lesser extent in mixed types but it was absent in cases of gram - negative bacteria. It was proved that total amount of Fn was more in gram positive bacteria than in gram -negative bacteria and in aerobes more than cases of anaerobes. Correlation between Fn distribution in CMS in relation to histopathological and bacteriological findings may be of special values as follows 1. Presence of interacellular Fn, and on the surface epithelium, indicates the presence of tissue damage and type of bacteria even with negative bacterial growth. 2. Metaplasia is a risky sign in CMS but with reasonable amount of Fn we may predict less risky prognosis. 3-Fn is usually present in pre-fibrotic stage and its amount may represent a good clue to prediction the healing process .4. Absence of Fn on surface epithelium, while the pathogen was gram- positive bacteria may indicate aeration defect of the antrum, and suggesting the line of treatment .Biopsy is mandatory in this study which may be a limiting factors, but it allows the recongnition, and categorization of the disease and gives valuble diagnostic and prognostic data on studing Fn distribution and histopathological pattern in CMS in relation to histological and bacteriological findings may be a suitable parameter for proposed a universal treatment proctocol