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Chronic inflammation: a poor prognostic factor for endoscopic dacryocystorhinostomy

European Archives of Oto-Rhino-Laryngology volume 269, pages 839–845 (2012)Cite this article

Abstract

Endoscopic endonasal dacryocystorhinostomy (En-DCR) success can be affected by many factors. In this study, we aimed to determine the effect of chronic inflammation on the surgical outcome of En-DCR. A series of 25 primary En-DCR cases and their lacrimal sac specimens were involved in the study. The surgical outcomes were assessed subjectively (satisfied and unsatisfied) and objectively (successful and unsuccessful). All the specimens were examined for the chronic inflammation related histopathological features (inflammatory cell infiltration, fibrosis and capillary proliferation) and graded according to their severity. Moreover, a “chronic inflammation score” was established to determine the intensity of chronic inflammation using the grade of histopathological features. A quantitative and statistical analysis of histopathological features and chronic inflammation were performed between patients with satisfactory and unsatisfactory outcome; and patients with successful and unsuccessful outcome. The overall success rate according to subjective and objective assessment was 60%. However, 9 of 10 patients with unsatisfactory and/or unsuccessful outcome (90%) had severe chronic inflammation of lacrimal sac. In subjective assessment, inflammatory cell infiltration (p = 0.050), fibrosis (p = 0.037), capillary proliferation (p = 0.007) and chronic inflammation (p = 0.003) had a statistically significant difference between patients with satisfactory and unsatisfactory outcome. In objective assessment, statistically significant differences were detected between patients with successful and unsuccessful outcome when they compared according to inflammatory cell infiltration (p = 0.027), capillary proliferation (p = 0.007) and chronic inflammation (p = 0.003). Chronic inflammation related histopathological features of variable degree may have a role on En-DCR outcome. Chronic inflammatory score can be used as an indicator of En-DCR success.

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References

  1. McKee SH (1925) The pathologic histology of the lacrimal sac in chronic purulent dacryocystitis. Trans Am Ophthalmol Soc 23:54–61

    PubMed  CAS  Google Scholar 

  2. Salour H, Hatami MM, Parvin M et al (2010) Clinicopathological study of lacrimal sac specimens obtained during DCR. Orbit 29:250–253

    PubMed  Article  Google Scholar 

  3. Anderson NG, Wojno TH, Grossniklaus HE (2003) Clinicopathologic findings from lacrimal sac biopsy specimens during dacryocystorhinostomy. Ophthalmol Plast Reconstr Surg 19:173–176

    Article  Google Scholar 

  4. Merkonidis C, Brewis C, Yung M, Nussbaumer (2005) Is routine biopsy of the lacrimal sac wall indicated at dacryocystorhinostomy? A prospective study and literature review. Br J Opthalmol 89:1589–1591

    CAS  Article  Google Scholar 

  5. Ünlü HH, Öztürk F, Mutlu C, İlker SS, Tarhan S (2000) Endoscopic dacryocystorhinostomy without stents. Auris Nasus Larynx 27:65–71

    PubMed  Article  Google Scholar 

  6. Unlu HH, Toprak B, Aslan A, Guler C (2002) Comparison of surgical outcomes in primary endoscopic dacryocystorhinostomy patients with and without silicone intubation. Ann Otol Rhinol Laryngol 111:704–709

    PubMed  Google Scholar 

  7. Moore WM, Bentley CR, Olver JM (2002) Functional and anatomic results after two types of endoscopic endonasal dacryocystorhinostomy: surgical and holmium laser. Ophthalmology 109:1575–1582

    PubMed  Article  Google Scholar 

  8. Toti A (1904) Nuevo metodo conservatore di cura radicale delle supporazini chronice del sacco lacrymale. Clin Med Firenze 10:385–389

    Google Scholar 

  9. Hallum AV (1948) The Dupuy-Dutemps dacrycystorhinostomy. Trans Am Ophthalmol Soc 46:243–261

    PubMed  CAS  Google Scholar 

  10. Koç A, Erginoğlu U, Karaaslan O (2004) Otorhinolaryngological procedures in fifteenth century in Anatolia. Ann Otol Rhinol Laryngol 113:414–417

    PubMed  Google Scholar 

  11. Oguz H (2004) The evolution of endonasal dacryocystorhinostomy. Surv Ophthalmol 49:543

    Google Scholar 

  12. Caldwell GW (1893) Two new operations for obstruction of the nasal duct, with preservation of the canaliculi. Am J Ophthalmol 10:189–192

    Google Scholar 

  13. West JM (1910) A window resection of the nasal duct in cases of stenosis. Trans Am Ophthalmol Soc 12:654–658

    PubMed  CAS  Google Scholar 

  14. Heermann H (1958) U8 ber endonasale chirurgie unter verwendung des binocularen mikroskopes. Arch Ohr Nas Kehlkopfheilk 171:295–297

    PubMed  CAS  Article  Google Scholar 

  15. McDonough M, Meiring JH (1989) Endoscopic transnasal dacryocystorhinostomy. J Laryngol Otol 103:585–587

    Google Scholar 

  16. Woog JJ, Kennedy RH, Custer PL, Kaltreider SA, Meyer DR, Camara JG (2001) Endonasal dacryocystorhinostomy: a report by the American Academy of Ophthalmology. Ophthalmology 108:2369–2377

    PubMed  CAS  Article  Google Scholar 

  17. The National Institute of Health and Clinical Excellence (2008) Interventional procedure overview of endoscopic dacryocystorhinostomy. The National Institute of Health and Clinical Excellence, London, UK, 26 October 2004. http://www.nice.org.uk/IP022overview, last Accessed 17 December

  18. Önerci M, Orhan M, Öğretmenoğlu O, İrkeç M (2000) Long-term results and reasons for failure of intranasal endoscopic dacryocystorhinostomy. Acta Otolaryngol 120:319–322

    PubMed  Article  Google Scholar 

  19. Unlu HH, Gunhan K, Baser EF, Songu M (2009) Long-term in endoscopic dacryocystorhinostomy: is intubation really required? Otolaryngol Head Neck Surg 140:589–595

    PubMed  Article  Google Scholar 

  20. Zenk J, Karatzanis AD, Psychogios G et al (2009) Long-term results of endonasal dacryocystorhinostomy. Eur Arch Otorhinolaryngol 266:1733–1738

    PubMed  Article  Google Scholar 

  21. Thakur D (1985) An observation on pathological changes of lacrimal sac in chronic dacryocystitis. Indian J Opthalmol 33:251–253

    CAS  Google Scholar 

  22. Çiftçi F, Erşanlı D, Civelek L et al (2005) Histopathologic changes in the lacrimal sac of dacryocystorhinostomy patients with and without silicone intubation. Ophthal Plast Reconstr Surg 21:59–64

    PubMed  Article  Google Scholar 

  23. Snead J, Rathbun JE, Crawford JB (1980) Effects of the silicone tube on the canaliculus: an animal experiment. Ophthalmology 87:1031–1036

    PubMed  CAS  Google Scholar 

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Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, Çivril State Hospital, Denizli, Turkey

    Özlem Özer

  2. Department of Otolaryngology-Head and Neck Surgery, Celal Bayar University, Manisa, Turkey

    Görkem Eskiizmir, Halis Ünlü & Asım Aslan

  3. Department of Pathology, Celal Bayar University, Manisa, Turkey

    Aydın İşisağ

  4. 52/56 Sokak No: 17 D: 6, Gokce apt. Esenyali, 35350, Izmir, Turkey

    Görkem Eskiizmir

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  1. Özlem Özer
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  2. Görkem Eskiizmir
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  3. Halis Ünlü
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  4. Aydın İşisağ
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  5. Asım Aslan
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Correspondence to Görkem Eskiizmir.

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Özer, Ö., Eskiizmir, G., Ünlü, H. et al. Chronic inflammation: a poor prognostic factor for endoscopic dacryocystorhinostomy. Eur Arch Otorhinolaryngol 269, 839–845 (2012). https://doi.org/10.1007/s00405-011-1728-2

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  • DOI: https://doi.org/10.1007/s00405-011-1728-2

Keywords

  • Dacryocystitis
  • Dacryocystorhinostomy
  • Inflammation
  • Treatment failure