Endonasal laser dacryocystorhinostomy---medium term results

Abstract

Background/aims-Endonasal laser dacryocystorhinostomy (ELDCR) has many potential advantages over conventional external DCR. Although the short term results of this technique have been reported, little is yet known of the long term results, and the occurrence of late rhinostomy failure. The aim of this study was to examine the results at 3 and 12 months following ELDCR. Method-The notes of all consecutiveELDCRs performed between November 1993 and May 1995 were retrieved. Demographic information, details of surgery, and the postoperative results were noted. Results-ELDCR procedures which did not undergo lacrimal stenting showed a short term success rate of 67% at 3 months, and a further failure rate of 9% at 12 months. ELDCRs which did undergo lacrimal stenting showed a short term success rate of 82% at 3 months, and a further failure rate of 21% at 12 months. Lacrimal intubation increased the long term success rate by 8%. The success rate was lower in the presence of local risk factors for nasal mucosal scarring. Conclusions-ELDCR requires some adjunctive treatment to improve maintenance of the nasal mucosal ostia if it is to compete successfully with external DCR on grounds other than cosmesis and patient convenience.

A consideration of the time taken to do dacryo-cystorhinostomy (DCR) surgery

“…2 EEL-DCR is often performed as day-case surgery under local anaesthesia using the holmium:YAG or the KTP laser. 3,5,7,11,16 Advantages of EEL-DCR over EES-DCR include even less blood loss during surgery and shorter operating time. These advantages make EEL-DCR suitable, for example, for the frail elderly patient, who otherwise might not be fit for longer lacrimal surgery, either under local or under general anaesthesia.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] The perceived disadvantages of the highly successful external approach dacryocystorhinostomy (DCR) [17][18][19][20][21] include the risk of cutaneous scar and lengthy surgery with significant blood loss. These reservations have fuelled the popularity of minimally invasive endonasal approaches.…”

“…In particular, the use of the holmium:YAG laser has increased the throughput of lacrimal surgery for many units. 11 However, success rates for both endoscopic endonasal surgical (EES) 4,6,10,16 and laser (EEL) 5,7,8,11,12,14,16 types of DCR are generally lower than for external DCR, 9,[18][19][20][21] resulting in more cases that will require secondary surgery.…”

Paediatric laser DCR

“…Endoscopic laser DCR was first described in cadavers by Massaro et al (1990). Laser DCR (ELDCR) in adults has a 70-80 % success rate (Boush et al 1994;Sadiq et al 1997). The laser is fast, atraumatic, with no sutures and minimal bleeding.…”

“…This is not significantly different from the success rate in adults. A more recent review of 258 external approach DCR's in children under the age of 16 reported a success rate of 96% (Hakin et al 1997) Endoscopic laser DCR has been reported in adults, with success rates of 70-80% (Boush et al 1994;Sadiq et al 1997). There are no reported studies of endoscopic laser DCR in children.…”