A case of endonasal balloon‐assisted dacryoplasty after failure of endonasal dacryocystorhinostomy

Indelicato, Pietro; Vinciguerra, Alessandro; Resti, Antonio Giordano; Trimarchi, Matteo

doi:10.1002/ccr3.2956

Cited by 4 publications

(6 citation statements)

References 37 publications

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“…If a secondary re-stenosis of the neo-rhinostomy occurs, END-DCR seem to be the treatment of choice since it provides direct visualization of intranasal abnormalities which cause surgical failure, with no superiority demonstrated over EXT-DCR 28 . In addition to this, a new endoscopic approach has been proposed, based on endonasal balloon dilatation of the stenotic neorhinostomy, with encouraging data 29,30 (Fig. 3).…”

Section: Distal Lacrimal Obstructionsmentioning

confidence: 99%

Multidisciplinary approach to lacrimal system diseases

Trimarchi

Vinciguerra

Resti

et al. 2021

Acta Otorhinolaryngol Ital

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Pathologies of the lacrimal drainage system range from benign to malignant lesions. However, independently of the etiological origin, the most common presenting symptom is represented by epiphora due to the dysfunction of the lacrimal system. Different diagnostic tools are now available, but for the most the first diagnostic approach is characterized by an ophthalmological visit, associated with nasal endoscopy, usually performed by an otolaryngologist. Frequently the diagnostic work-up is completed with a radiological exam (e.g. maxilla-facial CT or dacryocystography), whose role is still to be determined. Once a diagnosis has been made, different treatments are available in relation to the type of the disease, and commonly need close cooperation between an ENT and ophthalmic surgeon given the close anatomical structures involved. Taking into account all these aspects, the aim of this review is to highlight how a multidisciplinary approach to lacrimal pathologies is mandatory from diagnosis to treatment in order to offer the best clinical approach.

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Section: Distal Lacrimal Obstructionsmentioning

confidence: 99%

Multidisciplinary approach to lacrimal system diseases

Trimarchi

Vinciguerra

Resti

et al. 2021

Acta Otorhinolaryngol Ital

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“…7,15 Balloon dacryoplasty involves serial dilation of the duct and has lower success rates but should be considered particularly as a less invasive revision option after failed DCR or if surgery or anesthesia is contraindicated. 18,19 Lower lid tightening has shown up to 50% success, even with laxity as low as 6 to 10 mm. 7 Injection of botulinum toxin into the palpebral lacrimal gland has been found to be generally safe and effective, albeit with more established physiological indications, such as aberrant cranial nerve VII, complications from submandibular gland transplant, or paroxysmal hypersecretion.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Endonasal Dacryocystorhinostomy Performed for Functional Nasolacrimal Obstruction With Delay on Dacryoscintigraphy

Hodgson,

Hussain

2023

Journal of Craniofacial Surgery

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Purpose: To report the demographics and outcomes of endonasal dacryocystorhinostomy (DCR) following dacryoscintigraphy (DSG) performed for a series of patients with functional epiphora. Methods: Case series of endonasal DCR outcomes in patients with symptomatic epiphora with no evidence of lacrimal hypersecretion or lacrimal pump failure, minimal regurgitation noted on syringing, and DSG-confirmed delayed drainage. A successful outcome was defined as 80% subjective improvement or resolution of tearing on the operated side. Patient charts, DSG results, and operative records were examined, and data were collected. Relevant literature was reviewed and discussed. Results: The case series included 15 eyes of 10 patients. The mean age was 61.7 years at the time of surgery. Most cases (n=13) had post-sac obstruction, retention, or delay. One patient had pre and post-sac retention. A total of 12 cases had success after endonasal DCR, and 3 cases had failure. Follow-up for all operated patients was over 6 months. There were no reported complications by the surgeon or patients. Conclusions: Patients with functional epiphora confirmed by DSG seem to have a high success rate after endonasal DCR. In patients with symptomatic epiphora with subjective patency on syringing, the use of DSG in decision-making and outcome prediction may be supported. Further studies, including clinic-based tests, to demonstrate functional obstruction are warranted.

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“…In recent years, a balloon-assisted dacryoplasty approach has been described for revision cases and represents a valid mini-invasive procedure in which a pneumatic force (the balloon catheter) determines an enlargement of the stenotic tract with no bone exposure and, consequently, less fibrosis or granulation tissue [ 29 , 30 ]. This innovative technical approach was first delivered through a trans-canalicular manner [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Long-term results of a balloon-assisted endoscopic approach in failed dacryocystorhinostomies

Vinciguerra

Indelicato

Resti

et al. 2021

Eur Arch Otorhinolaryngol

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Purpose Endoscopic endonasal balloon-assisted dacryoplasty is a minimally invasive surgical approach that can be applied after failure of dacryocystorhinostomy with recurrence of distal acquired lacrimal obstruction. Methods At the Department of Otolaryngology, San Raffaele Hospital, Milan (Italy), from December 2016 to October 2020, 14 patients underwent trans-nasal balloon-assisted dacryoplasty after a failed dacryocystorhinostomy (both external and endoscopic endonasal). The routinary pre-operative work-up included multidisciplinary study of the lacrimal disease, which consisted in primary ophthalmological and otorhinolaryngological visits associated with nasal endoscopy, in which a radiological exam was added if needed. The surgical approach includes pneumatic enlargement of the stenotic rhinostomy, created during the primary dacryocystorhinostomy, using a high-pressure trans-nasal balloon catheter. Anatomical success was considered when the ostium was patent upon irrigation, while functional success was considered as resolution of epiphora or free lacrimal flow on functional test. Results Among 14 patients included and after a mean follow-up of 19.5 months (range 13-51 months), anatomic success was achieved in 100% of patients and functional success was achieved in the 85.7% (12/14). Operative time ranged from 9 to 28 min (mean 18 min) and no complications were reported. Conclusion Trans-nasal balloon-assisted dacryoplasty is a mini-invasive surgical approach to treat failed dacryocystorhinostomies with reliable and stable outcomes in the long term. The absence of post-surgical complications, high success rate and short operative time are the main features of this innovative procedure.

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A case of endonasal balloon‐assisted dacryoplasty after failure of endonasal dacryocystorhinostomy

Cited by 4 publications

References 37 publications

Multidisciplinary approach to lacrimal system diseases

Multidisciplinary approach to lacrimal system diseases

Outcomes of Endonasal Dacryocystorhinostomy Performed for Functional Nasolacrimal Obstruction With Delay on Dacryoscintigraphy

Long-term results of a balloon-assisted endoscopic approach in failed dacryocystorhinostomies

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