A clinicopathologic study of nasal mucosa in 350 patients with external dacryocystorhinostomy.
OBJECTIVE
To analyze the frequency, pattern, and extent of chronic inflammation and scarring in nasal mucosa specimens obtained during external dacryocystorhinostomy (DCR), and to correlate these findings with clinical data.


METHODS
We reviewed the clinical and histopathologic data of 350 consecutive patients without clinical evidence of rhinological diseases who underwent primary DCR for acquired dacryostenosis.


RESULTS
The mean age of the patients (238 females and 112 males) at the time of surgery was 57.4 years (range 34-95 years). Of the 350 patients, 189 (54%) had clinical evidence of acute dacryocystitis previously. Acute dacryocystitis was present in 55 patients (16%) less than one month prior to surgery, in 86 patients (25%) one to six months prior to surgery, and in 48 patients (14%) more than six months prior to surgery. The mean duration of preoperative symptoms (e.g., epiphora, purulent discharge) was 30.2 months (range 1-220 months). The postoperative success rate was 92% (mean follow-up 40.3 months, range 12-93 months). Histopathologically, the presence of chronic inflammation was noted more frequently (p < 0.001, Kruskal-Wallis test), with a shorter time interval between surgery and last dacryocystitis. The presence of subepithelial scarring was detectable more often (p < 0.001, Kruskal-Wallis test), with a longer time interval between surgery and last episode of dacryocystitis. Postoperative success was more common in patients with a shorter duration of preoperative symptoms (p = 0.005, Mann-Whitney test) and with a shorter time interval between surgery and last dacryocystitis (p < 0.001, Student's t-test).


CONCLUSIONS
The histopathologic presence of subepithelial scarring and shrinkage in nasal mucosa biopsy specimens was associated with longer time intervals between dacryocystitis and surgery as well as with less favorable postoperative outcomes. The results of the present study suggest that patients should undergo rather early surgery following the regression of acute inflammation.
Heindl
Ludwig M
LM
Department of Ophthalmology, Eye Hospital, University Erlangen-Nurnberg, Erlangen, Germany. ludwig.heindl@uk-erlangen.de
Junemann
Anselm
A
Holbach
Leonard M
LM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002921:Cicatrix / Q000453:epidemiology; D003608:Dacryocystorhinostomy / Q000379:methods*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000473:pathology* / Q000601:surgery*; D009301:Nasolacrimal Duct / Q000601:surgery*; D012372:ROC Curve; D016896:Treatment Outcome