Reliable technique of Endoscopic Dacryocystorhinostomy – A Pilot Study (original) (raw)
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Endoscopic Endonasal Dacryocystorhinostomy- an upcoming modality
Purpose. The aim of this study is to propose a simple and efficient combination surgery for the management of dacryocystitis with canalicular obstruction. Methods. A retrospective noncomparative case series of dacryocystitis with canalicular obstruction has been studied. Twelve patients with dacryocystitis and canalicular obstruction underwent a conventional endoscopic endonasal dacryocystorhinostomy (EE-DCR) combined with a modified canalicular repair. Postoperative observations included slit lamp, fluorescein dye disappearance test, lacrimal syringing, lacrimal endoscopy, and nasal endoscopy. Results. After 6-18 months of postoperative follow-up, the symptoms of epiphora and mucopurulent discharge disappeared completely in 10 patients, and occasional or intermittent epiphora remained in 2 patients. All of the twelve patients showed an opened intranasal ostium and normal fluorescein dye disappearance test. Patent bicanalicular irrigation was achieved in 9 patients. One patient had a partial and the other two had a complete reobstruction by lacrimal irrigation to their repaired lower canaliculus; however, all of them had a patent lacrimal irrigation to upper canaliculus. The functional success rate for the combination surgery is 83% (10/12), and anatomical success rate is 75% (9/12). Conclusion. EE-DCR combined with modified canalicular repair is a simple and efficient method for the management of dacryocystitis with canalicular obstruction.
Comparison of surgical outcomes of endonasal dacryocystorhinostomy with or without mucosal flaps
Auris Nasus Larynx, 2009
Objective: The goals of this study were to evaluate the long-term results of endoscopic endonasal dacryocystorhinostomy (DCR) with or without a posterior mucosal flap and to compare the surgical success rates of that procedure in patients with a nasolacrimal duct obstruction. Patients and methods: We retrospectively investigated the results of 78 endoscopic endonasal DCRs performed at the Baskent University, Department of Otolaryngology between December 2000 and March 2007 on 74 patients with a lacrimal obstruction. The patients were divided into two groups. During surgery, the posterior mucosal flap was preserved in 27 patients (group A) and removed in 47 patients (group B). All patients underwent intubation with a silicone tube at the conclusion of surgery. The silicone tube was removed within 6 months after surgery. The mean follow-up period was 36 months (range, 2-78 months). The results obtained were then compared. Results: Granulation tissue and synechia developed between the lateral nasal wall and the middle turbinate in one patient in group A (revision surgery was not required). In group B, granulation tissue at the rhinostomy opening was found in seven patients, and in four of those subjects, the granulation tissue obstructed the neo-ostium. These four patients underwent a second operation. In group B, synechia was noted between the middle turbinate and the lateral nasal wall in two of 47 patients. In group A, the procedure was successful for all patients except one in whom granulation tissue developed, and in group B, the surgical success rate was 88.3%. Conclusion: In endoscopic endonasal DCR, the closure of bare bone with a posteriorly based nasal mucosal flap that creates an anastomosis between the lacrimal sac mucosa and the nasal mucosa decreases the formation of granulation tissue. But, there is no significant difference of success rate between two groups.
Endonasal dacryocystorhinostomy: evaluation of the anatomical and functional results
2020
Background: Dacryocystorhinostomy is a novel surgical technique for NLD obstruction performed by external and endonasal approach. Both procedures have variable success rates and advantages or disadvantages. The objectives were to study functional and anatomic outcomes of endoscopic DCR and to assess degree of ostium shrinkage in postoperative period. Methods: Prospective study comprising 68 patients of NLD obstruction with 70 procedures performed during the period of October 2014 to October 2016. Various dimensions of bony neo-ostium were recorded intraoperatively and during 1st and 3rd month follow up. Mitomycin C was applied in 37 cases. Degree of ostium shrinkage and its correlation with surgical success was studied. Outcome of study was measured as functional and anatomical success. Results: 68 patients in age range of 7 to 71 years. Mean intraoperative height and width were 12.0±2.08 mm and 5.17±0.82 mm respectively and intraoperative surface area of ostium was 62.77±17.27mm 2 ...
Endoscopic dacryocystorhinostomy: personal experience
Acta otorhinolaryngologica Italica : organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale, 2005
Data are reported on a series of 52 endoscopic procedures of dacryocystorhinostomy, performed in the Department of Otorhinolaryngology of the Hospital of Varese, between May 1999 and February 2003. The study population comprised 42 patients (32 female, 10 male. mean age 57 and 51 years, respectively) with naso-lacrimal obstruction. In all cases, pre-operative diagnosis consisted in irrigation of the lacrimal pathways, confirmed on dacryocystography; in selected cases, an additional computed tomography examination was carried out. All procedures were performed under general anaesthesia and surgical times were recorded; mean time for primary dacryocystorhinostomy was 30 minutes. A silicone tube was inserted in all patients for a period of 3 months. The procedure was successful in 81% of primary dacryocystorhinostomy cases and in 75% of revision dacryocystorhinostomy cases. Personal clinical and surgical experience, focusing on surgical techniques used in dacryocystorhinostomy, is desc...
Ophthalmic Plastic & Reconstructive Surgery, 2010
In the last 15 years, endonasal dacryocystorhinostomy (End-DCR) has become an alternative to external dacryocystorhinostomy. In most series reported, it appears that End-DCR had a higher failure rate than Ext-DCR. Uncontrolled epithelialization of the surgical site as compared with the fashioning of mucosal flaps may explain the somewhat lower success rate. The purpose of our study is to validate a modification of a new technique described by Tsirbas and Wormald in which the nasal mucosa is preserved and brought in contact with the lacrimal mucosa during End-DCR, leaving an epithelialized surgical site at the end of the operation. Methods: A retrospective study was performed from November 2001 to January 2003. Patients with epiphora and or chronic or recurrent dacryocystitis were evaluated. Patients with symptomatic nasolacrimal duct obstruction (NLDO) and who met the criteria for End-DCR were selected. NLDO was diagnosed based on symptoms, along with a blocked irrigation or an abnormal bone substract dacryocystogram. The surgical procedure involved a manual osteotomy of the frontal process of the maxilla and removal of the lacrimal bone with the creation of posteriorly hinged lacrimal sac and nasal mucosal flaps. Results: Forty-five patients underwent End-DCR with preservation of the lacrimal and nasal mucosa. Five patients had bilateral surgery. A total of 50 surgeries were performed. Twenty-four surgeries were performed on the right side and 26 on the left. Patients were evaluated at 1 week, 1 month, and 3 months after surgery. Evaluation included asking about subjective symptoms of epiphora, lacrimal irrigation on the 3 visits, and endoscopic evaluation of the surgical site at 3 months. Surgery was considered successful when patients did have relief of their epiphora and had a patent system with irrigation. Forty-nine patients (98%) were asymptomatic at 1 month and at 3 months with both a patent system tested with irrigation and a patent ostium evaluated with the endoscope. One patient who had undergone bilateral surgery had blockage of the fistula on the left side at 3 months. The patient underwent endoscopic revision surgery and was patent 1 year afterward. A phone survey
Evaluation Of Intranasal Ostium In External Dacryocystorhinostomy
Medical Journal of Trakya University, 2010
Objective: The investigation of factors affecting the dimension and configuration of the intranasal ostium in successful external dacryocystorhinostomy (DCR). Material and Methods: Fifty-one patients were enrolled within this study. During operation, dimensions of bone window were measured. In the postoperative sixth month, changes in bone window size were evaluated using spiral paranasal tomography, and the intranasal ostium was examined with nasal endoscopy. Results: There were 19 patients who underwent DCR and 32 patients who underwent DCR+silicone tube intubations (SI). The mean bone window size was 214.37 mm 2 during operation and 214.87 mm 2 after six months. The mean intranasal ostium size was measured as 51.42 mm 2 for patients who had undergone DCR and 28.66 mm 2 for the DCR+SI cases. The endoscopic appearance of the ostium was observed as oval or round for the DCR cases and in slit form for the DCR+SI cases. A multiple logistic regression model showed that silicon tube intubation posed an 11 times greater risk for configuration distortion in the intranasal ostium (p=0.0079). Conclusion: Postoperative intranasal ostium size has a relation with the intraoperative bone window size. The difference of mean intranasal ostium sizes of DCR and DCR+SI cases was not statistically significant. However, because SI gives rise to ostium configuration by triggering fibrosis, it should not be carried out unless absolutely necessary.
Topic: A Comparative Study between Conventional and Endoscopic Dacryocystorhinostomy
Introduction: Dacryocystorhinostomy (DCR) has been the standard procedure for acquired nasolacrimal duct obstruction. Lacrimal sac can be approached (1) Conventional External (Ex-DCR) or (2) Endoscopic (EN-DCR) Objective : To compare success rate , complication rate between the procedures Materials and Methods: Study design, prospective, interventional , clinical study was conducted in department of otorhinolaryngology in conjuction with ophthalmology,AMCH ,Duration of study : One year , from july 2011 to june 2012 , No. of cases : 60 cases(30 Endo-DCR,30 Ex-DCR) . Data were analysed by graphpad prism version 6.01 for Microsoft, Independent-sample t test &, chi square test with Yates correction was applied for comparison between groups , P value of <0.05 was considered stastically significant . Results and Observations : Total 60( 47 females,13 males) cases randomised into 30( 27females, 3males) endoscopic dcr, 30( 20females,10 males) external dcr, Mean age (32.367 )with range 18-55 yrs. in endoscopic dcr, Mean age (37.534 )with range 16-66 yrs. in external dcr. Present study shows success rate of 86.67% for En-DCR & 90% for Ex-DCR with P-value 0.557 CONCLUSION : The present study clearly shows that En-DCR is having results comparable EX-DCR ,
Bengal Journal of Otolaryngology and Head Neck Surgery, 2021
Introduction Endoscopic dacryocystorhinostomy aims to establish a patent nasolacrimal fistula. Use of silicone stent is a preferred modification to achieve long term patency of neo-ostium, though it has been blamed for granulations, synechia and punctal erosion. Present study was done to evaluate and compare the outcomes of Endoscopic dacryocystorhinostomy with and without stent. Materials and Methods 40 patients of with chronic dacryocystitis and nasolacrimal duct blockage were selected for the study. Nasal endoscopy was done for suitability of surgical access and to detect any nasal pathology. Sac syringing was done to assess the site of blockage and Dacryoscintigraphy to confirm it. 20 patients in Group A underwent Endoscopic dacryocystorhinostomy without stent and remaining 20 in Group B with silicone stent. Success rates were determined by subjective relief from epiphora and by endoscopic visualization of rhinostomy opening, granulation tissues/ synechiae at rhinostomy site...