How we do it: The viability of free mucosal grafts on exposed bone in lacrimal surgery – a prospective study

Abstract

To ascertain viability of free mucosal of grafts on bare bone and degree of contracture in vivo. Prospective study to ascertain graft survival where a small piece of mucosa, with a single centrally placed prolene suture for future identification, removed during endoscopic dacrocystorhinostomy (DCR) was replaced to cover exposed bone at the end of the procedure. The presence of the graft and the degree of contracture was assessed endoscopically in outpatients at the second and fourth weeks. All patients who fulfilled the inclusion criteria who underwent DCR in the study period April-October 2002. All the grafts survived intact at 4 weeks after the operation. Grafts underwent up to 20% contracture over this period. Free mucosal grafts survive well when applied to denuded bone in DCR operation.

Improved Surgical Outcome of Endonasal DCR With Preservation of Nasal Mucosal Flaps

“…To prevent the complication Mahendran and colleagues have used a free mucosal flap to cover the bare bone in patients underlying endoscopic endonasal DCR. (14) We support the combination of large bony ostium, which is a proposal of Wormald and covering bare lacrimal bone with preserved nasal mucosa at the end of surgery as explained by Mahendran and Colleagues help to achieve post-op success rate almost near 99%.…”

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.…”

Endoscopic ‘cold steel’ versus laser dacryocystorhinostomy: completing the audit cycle

“…Endonasal cold steel DCR continues to undergo revision and refinement. A recent study suggests that a free mucosal graft covering the exposed bone adjacent to the lacrimal window may improve primary intention healing, potentially decreasing scar formation 13 . Another suggested method of improving the size of the rhinostomy is to use a drill rather than ronjeurs.…”