Value of adding autologous adipose-derived stem cells to intranasal submucosal fat implant for management of empty nose syndrome

Abstract

Background Empty nose syndrome (ENS) is an iatrogenic disorder caused by too much nasal turbinate resection. Stem cell therapy can be used to repair, replace, or restore the biological function of a damaged tissue or organ. Aim To evaluate the role of adding autologous adipose-derived stem cells (ADSCs) therapy to intranasal submucosal fat implant for management of ENS and to compare its efficacy and safety to improve nasal functions in patients with ENS. Patients and methods Fifty-two patients having ENS were randomly distributed in two equal groups: group I was subjected to endoscopic intranasal submucosal fat implant injection and group II was subjected to intranasal submucosal fat implant with ADSCs injection at the site of inferior turbinate stump. Subjective evaluation was done by reviewing the SNOT-25 test, whereas objective evaluation was done by nasal endoscopy and nasal clearance test. Histopathological examination and reverse transcription-PCR were done to assess mucosal regeneration. Results Postoperative objective evaluation by anterior rhinoscopy and nasal endoscopy showed rapid healing with no signs of implant infection, rejection, or allergic reaction in both groups. Both groups experienced a statistically significant improvement in both SNOT-25 and mucociliary clearance tests after surgery. There was a positive statistical significant between the two groups from 6 months postoperatively. Both histopathological examination and reverse transcription-PCR showed evidence of mucosal regeneration in group II patients by detection of mucin-4 and lysozyme expression in regenerated nasal mucosa. Conclusion Adding ADSCs to intranasal submucosal fat implant augments the results and durability of improvement and also restores the anatomical and physiological functioning of nasal mucosa.