Long‐term Outcomes for Revision Endoscopic Dacryocystorhinostomy—The Effect of the Primary Approach

Acta Otorhinolaryngol Ital

et al. 2021

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.

Section: S106mentioning

confidence: 99%

Multidisciplinary approach to lacrimal system diseases

Trimarchi

Acta Otorhinolaryngol Ital

et al. 2021

“…It seems reasonable that this should be a minimum of 6 months for primary surgery and up to 18 months for revision surgery. 47 …”

Section: Resultsmentioning

confidence: 99%

Endoscopic and external dacryocystorhinostomy: A therapeutic proposal for distal acquired lacrimal obstructions

European Journal of Ophthalmology

Rampi

et al. 2022

Endoscopic (END-DCR) and external dacryocystorhinostomies (EXT-DCR) are nowadays considered the gold standard techniques for non-oncologic distal acquired lacrimal disorders (DALO). However, no unanimous consensus has been achieved on which of these surgeries is the most suitable to the individual patient. Herein, we review the available literature of the last 30 years with the aim of defining a simple and reproduceable treatment algorithm to treat DALO. A search of PubMed, EMBASE, Scopus and Cochrane databases was last performed in December 2021 to examine evidence regarding the role of END-DCR and EXT-DCR in primary and revision surgeries. If considered primary surgeries, END-DCR should be preferred in case of intranasal comorbidities, given the possibility to directly visualize and treat potential intranasal pathologies. Conversely, EXT-DCR should be chosen in case of need/preference for local anesthesia, given the major historical experience and wider surgical field that helps to resolve intra-operatory complications (e.g., bleeding) in an uncollaborative patient. In the absence of the abovementioned conditions, the decision of one or other approach should be discussed with the patient. In recurrent cases, END-DCR should be considered the treatment of choice given the major likelihood to visualize the causes of primary failure and directly resolve it. In conclusion, END-DCR should be considered the treatment of choice in revision cases or in primary ones associated with intranasal pathologies, whereas EXT-DCR should be chosen if local anesthesia is needed. In the absence of these scenarios, it is still open to debate which of these two approaches should be used.

“…In particular, our previously reported revision END-DCRs with a powered approach has demonstrated, among 96 patients, a functional success rate of 85.1% at mean follow-up of 38 months [ 14 ], whereas Ali et al [ 27 ] described 23 cases of revision END-DCR with a mean follow-up of 26.4 months reporting an anatomical and functional success rates of 91.3% and 86.9%, respectively, both data in line with our END-DCP results. Conversely, another revision END-DCR case-series made by Allon et al [ 17 ] presented lower success, with yearly rates, from immediate to 5 years, of 93.3%, 75.5%, 71.1%, 68.9%, 68.9%, and 68.9%, respectively. Even if dichotomous compared to the work of Ali et al, the difference noted with the latter study can be explained by the less invasiveness and bone exposure of balloon END-DCP compared to standard END-DCR, which is also demonstrated by the reduced surgical time and the possibility to perform the balloon-END-DCP in local anesthesia [ 19 ].…”

Section: Discussionmentioning

confidence: 97%

“…In particular, the most common reasons for unsuccessful DCRs are excessive cicatricial ostium closure or granulation tissue formation, inadequate osteotomy/sac opening, internal ostium stenosis, common canalicular obstruction and sump syndrome [ 16 ]. Excluding the last two reasons, which require specific ophthalmological management, the others determine intranasal ostium stenosis which is mainly treated either with an endoscopic or external approach [ 17 ]. However, even if no significant difference has been noted, over the past few years, the END-DCR has gained popularity among clinicians for revision surgeries because, using endoscopic instrumentation, it provides a direct identification of the cause for the surgical failure and permits its rectification [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

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

Indelicato

Eur Arch Otorhinolaryngol

et al. 2021

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.