Anastomosis of nasal mucosal and lacrimal sac flaps in endoscopic dacryocystorhinostomy

Abstract

Endoscopic dacryocystorhinostomy (DCR) is a well-established alternative to external approaches in the treatment of nasolacrimal canal obstruction. From July 2004 to December 2008, 92 endoscopic DCRs were performed on 88 patients at the Department of Otorhinolaryngology, San Raffaele Hospital, Milan. All patients were affected by chronic dacryocystitis with epiphora. Preoperative work-up included Jones tests, lacrimal pathways irrigation, nasal endoscopy, and imaging evaluation by computed tomography. The technique involved anastomosis of nasal mucosal, lacrimal sac flaps and a large bony ostium. A silicone tube was inserted in all patients that remained for a period of 3 months. The first endoscopic intervention was successful in 91.30% of patients. After a second revision endoscopic DCR, the overall success rate raised to 95.65%. Anastomosis of nasal mucosal between lacrimal sac flaps plays a key role in endoscopic DCR with a high success rate both in primary nasolacrimal obstructions and in revision cases.

Acute Dacryocystitis with Empyema of the Lacrimal Sac: Is Immediate Endoscopic Dacryocystorhinostomy Justified?

“…We generally cover the bone by mucosal rotational flaps according to a technique that, with some minor differences, has already been described and is intended to favor primary intention healing. 11,12,20,21 When allowed by anatomic conditions, we harvest 4 flaps, with 2 obtained by extroversion of the lacrimal sac mucosa and 2 by a posteriorly based mucoperiosteal flap.…”

Effects of Merogel coverage on wound healing and ostial patency in endonasal endoscopic dacryocystorhinostomy for primary chronic dacryocystitis

“…2,8,[9][10][11]14 Our technique involves removal of the nasal mucosa flap and the creation of a large C-shaped lacrimal sac flap that is laid flat posteriorly to cover the lateral nasal mucosal wall, as described by Wu et al 39 We appose the lacrimal sac flap border with the nasal mucosal wall. At the 2-week review, we observed that more patients in the Merogel group had healthy epithelial-lined ostia, especially in the areas between the lacrimal sac and the lateral nasal mucosa wall, than the control group.…”

“…The success rate for EES-DCR, however, varies markedly from 54 to 96%. [1][2][3][4][5][6][7][8] Numerous modifications have been developed to promote ostial patency, ranging from various methods of producing the nasal mucosal and/or lacrimal sac flaps, 2,4,[9][10][11][12] varying the size of the bony ostium, 4,[12][13][14] lacrimal sac incision, 15 to stenting. 16,17 Nevertheless, ostial closure or obstruction still occurs, mostly due to excessive scars/synechia or granulation formation at the ostium.…”

“…16,17 Nevertheless, ostial closure or obstruction still occurs, mostly due to excessive scars/synechia or granulation formation at the ostium. 3,5,6,8,9,[18][19][20] Some authors advocate the use of mitomycin C (MMC) intraoperatively to reduce fibrosis formation, [21][22][23][24][25][26] although granulation tissue has been reported to form around the ostia following MMC application during EES-DCR. 27,28 Hyaluronan is a ubiquitous polysaccharide component of the extracellular matrix.…”

Long‐term outcomes in revision powered endoscopic dacryocystorhinostomy

“…Endoscopic dacryocystorhinostomy (DCR) is commonly performed for managing nasolacrimal duct obstructions with high success rates . However, failures have been reported in up to 10% of the patients . The common surgical causes of failures include inability to correctly locate the sac, insufficient osteotomy, inadequate sac opening, and significant but uncorrected septal deviations and concha bullosa .…”