Title : Histopathological and functional analysis of nasal mucosa in primary and revision dacryocystorhinostomy: A comparative study
Abstract:
Objectives: This study aims to compare the histopathological and functional characteristics of nasal mucosa specimens from patients undergoing primary versus revision dacryocystorhinostomy (DCR). The objectives were to identify key histological differences, with particular emphasis on inflammatory changes, and to explore clinical factors contributing to the need for revision surgery. Additionally, the study sought to evaluate how these histopathological and clinical differences influence surgical outcomes and the long-term success of DCR procedures.
Methods: Twenty-four patients undergoing primary DCR and twenty-one patients undergoing revision DCR surgery were enrolled in the study. All participants were assessed for a history of dacryocystitis, asthma, allergic rhinitis, duration of epiphora, and nasal spray usage in the month preceding surgery. Histopathological evaluation included the assessment of tissue inflammation, subepithelial fibrosis, submucosal epithelial goblet cell density, and mucosal mucous gland density. All patients were evaluated at both the first and sixth postoperative months.
Results: In primary cases, dacryocystitis and the presence of purulent secretion were more common (p = 0.001, p = 0.013, respectively). Among all cases, the frequency of allergic rhinitis and asthma was associated with purulent secretion (p = 0.012). Histopathological findings revealed that submucosal epithelial goblet cell density was higher in primary cases, while the degree of subepithelial fibrosis was more pronounced in revision cases (p = 0.001, p = 0.003, respectively). Primary cases had a longer duration of symptoms, which was positively correlated with tissue inflammation and subepithelial fibrosis (p = 0.001, p = 0.002, r = 0.622; p = 0.042, r = 0.429, respectively). In revision cases, patients not using nasal spray, as well as those without asthma or allergic rhinitis, exhibited lower levels of inflammation (p = 0.002, p = 0.022, respectively). Among all patients, those diagnosed with asthma or allergic rhinitis demonstrated higher levels of inflammation in nasal mucosa specimens (p = 0.026). Furthermore, patients who were not using nasal sprays had lower inflammation in their specimens (p = 0.015).
Conclusion: This prospective study demonstrates that, in addition to differences in surgical technique and bone ostium size between primary and revision cases, patients' backgrounds and nasal mucosal histopathological characteristics exhibit notable distinctions. Primary cases displayed increased mucosal and submucosal gland densities, while revision cases were characterized by more pronounced tissue fibrosis. Furthermore, rhinitis and asthma exacerbated both clinical symptoms and histopathological findings. Additionally, nasal spray use was associated with increased tissue inflammation in the nasal mucosa. These findings suggest that the outcomes of DCR surgery and the management of these patients are not solely influenced by surgical techniques, but are also significantly affected by the inherent properties of the nasal mucosa, the presence of ongoing allergies or related conditions, and the use of nasal sprays.
