Endonasal Dacryocystorhinostomy with Mucosal Flaps: Our Experience

Abstract

The endoscopic dacryocystorhinostomy (DCR) has distinct advantage over external DCR. There is no ugly scar on the face, less intraoperative bleeding, it is a daycare procedure and patient is discharged on the same day evening. Endoscopic DCR is considered to be a superior alternative technique to the conventional external DCR. Patients diagnosed with nasolacrimal duct obstruction between Jan 2009 and Jan 2011 were included in the study. One hundred and twenty endo DCR were performed with conventional 'cold steel' instruments. The technique involved complete exposure and marsupialization of the lacrimal sac. The surgical technique involved the creation of nasal mucosal and large posterior lacrimal flaps at the medial lacrimal sac wall and the two flaps were placed in close apposition. Success was defined as complete resolution of epiphora and a patent lacrimal system, evaluated by lacrimal irrigation and endoscopy, 1 year postoperatively.

Comparison of different surgical methods in endonasal dacryocystorhinostomy

“…Our median follow-up period was 15 During follow-ups, recurrences were seen in one patient both in Groups 1 and 2, and 6 patients in Group 3. No recurrence was seen in 80.5% of the patients participated in the study while 19.5% of the patients experienced recurrences.…”

“…[1] In the literature, surgical success was defined as elimination of complaints of epiphora within the first postoperative year and demonstration of a patent lacrimal system using lacrimal system lavage and endoscopic examination. [15] In their study, Tsirbar and Wormald expressed the secret of a successful DCR procedure as nearly complete excision of the bone tissue covering lacrimal sac and its approximation with mucosal flap constructed from nasal mucosa by marsupialization of lacrimal sac mucosa. [16] Liang et al indicated that excision of bony processes surrounding newly-constructed ostium in order to create a cavity with a smooth surface increases surgical success rates.…”

Intraoperative prevention of dacryocystitis relapse

“…Большинство исследователей считают, что высокую эффективность при ДЦР можно достичь путем выкраивания лоскута из медиальной стенки слезного мешка [6,16,17]. Однако форма выкроенного лоскута и его расположение в полости носа различаются.…”

“…A. Majumder и соавт. [6] откидывали лоскут в форме буквы «U», созданный из медиальной стенки слезного мешка. Положительный результат после операции был получен в 93% случаев.…”

“…[32] использовали для интубации дакриостомы два моноканаликулярных имплантата Monoka, которые вводили через оба слезных канальца. B. Becker [7] считает, что в случае удаления фрагмента медиальной стенки слезного мешка требуется интубация дакриостомы для повышения эффективности эндоназальной эндоскопической ДЦР.…”