Management of acquired nasolacrimal duct obstruction: external and endonasal dacryocystorhinostomy. Is there a third way?

Patel, Bhupendra C.

doi:10.1136/bjo.2008.150136

Cited by 10 publications

(7 citation statements)

References 23 publications

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“…Endoscopic DCR has gained in popularity in recent years because it provides comparable results with external DCR while avoiding cutaneous incisions and disruption of the lacrimal pump mechanism of the orbicularis oculi, improved visualization of the intranasal neoostium, and enabled the concomitant management of potentially obstructing nasal anatomy. 1,16 However, this procedure mandates the surgical instrumentation of an otherwise potentially healthy nasal cavity, which could negatively impact nasal quality of life. Conversely, patients with asymptomatic septal deviation could theoretically have an incremental improvement in nasal function after correction of their anatomic obstruction for purposes of surgical access.…”

Section: Discussionmentioning

confidence: 99%

Impact of Endoscopic Dacryocystorhinostomy on Sinonasal Quality of Life

Miyake

Gregório

Freitag

et al. 2016

Am J Rhinol�Allergy

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Section: Discussionmentioning

confidence: 99%

Impact of Endoscopic Dacryocystorhinostomy on Sinonasal Quality of Life

Miyake

Gregório

Freitag

et al. 2016

Am J Rhinol�Allergy

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“…Patients with symptoms indicating complete NLDO are usually treated with bypass surgery in the form of dacryocystorhinostomy (DCR) [ 7 - 9 ] . The objective of DCR is to construct an anastomosis between the lacrimal sac and the nasal mucosa [ 8 , 10 - 13 ] .…”

Section: Introductionmentioning

confidence: 99%

Outcomes of external and endonasal dacryocystorhinostomy according to a modified Lacrimal Symptom Questionnaire (Lac-Q)

Torabi,

Stenstrom,

Larsson

et al. 2023

Med Hypothesis Discov Innov Ophthalmol

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Background: Nasolacrimal duct obstruction is usually treated using endoscopic or external dacryocystorhinostomy (DCR). The anatomic outcomes of both the endoscopic and external approaches are considered excellent. However, anatomic success does not translate into patient satisfaction. The current study assessed pre- and postoperative lacrimal problems using the symptom-based Lacrimal Symptom Questionnaire (Lac-Q) and investigated patient satisfaction depending on the choice of surgical technique. Methods: A total of 112 eligible patients with lacrimal problems treated using external or endonasal DCR at the ophthalmology and ear, nose, and throat clinics at Skane University Hospital, Sweden, over a four-year period, were enrolled in this retrospective study. Patients were considered eligible if they experienced preoperative epiphora and had lacrimal duct stenosis. They were offered treatment using either external or endonasal DCR and were allowed to freely choose the technique. Exclusion criteria consisted of previous ipsilateral DCR, congenital NLDO, age < 18 years, presence of cancer, previous orbital trauma, or noncompliance with postoperative follow-up. After surgery, the patients were sent the Lac-Q to evaluate their lacrimal symptoms pre- and postoperatively. Complementary questions were added pertaining to the operative scar and the patients’ overall satisfaction with the operation. Results: In total, 67 (60%) patients with ages ranging from 18 to 88 years completed the questionnaire, 33 (49%) of whom underwent external DCR and 34 (51%) endonasal DCR. Of the 67 respondents, 51 (76%) were women and 16 (24%) were men. Patients scored preoperative lacrimal problems highly on the Lac-Q, reporting both symptomatic and social problems due to epiphora. Following surgery, the group that underwent external DCR remained home from work for 2 – 14 days (median, 3.5 days). However, 17 (52%) were retired. After the endonasal DCR, the patients remained home for 0 – 7 days (median, 2 days). Most patients were satisfied after DCR surgery, with both techniques significantly improving total, lacrimal symptom, and social impact scores (all P < 0.001). No differences in postoperative satisfaction were observed between the external DCR and endonasal DCR groups (P > 0.05). A small number of patients expressed scar-related concerns after external DCR. Conclusions: The patients perceived lacrimal problems as a significant symptomatic and social burden. Postoperative satisfaction and symptom relief were good regardless of the surgical approach. Further prospective studies assessing patient satisfaction and its correlation with anatomical and functional success rates after external and endonasal DCR could provide robust, practical, real-world implications.

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“…4 The avoidance of a facial scar and preservation of the medial canthal ligament are further arguments for choosing an endonasal approach for surgical management of nasolacrimal duct obstruction. 5…”

Section: Introductionmentioning

confidence: 99%

Use of an image-guided navigation system for routine endonasal endoscopic dacryocystorhinostomy

Reichel

Taxeidis

2019

J. Laryngol. Otol.

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ObjectiveThis study aimed to evaluate the results of routine endonasal endoscopic dacryocystorhinostomy combined with computed tomography guided navigation in patients with nasolacrimal duct obstruction.MethodThis was a retrospective study of all patients with lacrimal drainage obstruction undergoing stereotactic endoscopic dacryocystorhinostomy between 1st January 2016 and 1st April 2018. Computed tomography dacryocystography was used for intra-operative navigation. Patients with a presaccal obstruction site location were excluded from the study.ResultsEndoscopic dacryocystorhinostomy with computed tomography guided navigation was successfully performed in all 17 cases without complications. Early post-operative dislocation of the inserted bicanalicular silicone stent occurred in two patients. Two other patients developed post-operative bacterial infection within the lacrimal sac. Otherwise, the silicone tube was removed three months after surgery, and after further follow up of 8 weeks, 94 per cent of the study population reported complete remission of epiphora.ConclusionThe use of computed tomography guidance in routine endoscopic dacryocystorhinostomy enhanced safety for the patient and avoided unnecessary damage of bone and mucosa surrounding the lacrimal drainage system. Therefore, routine endoscopic dacryocystorhinostomy with additional stereotactic guidance by computed tomography navigation can contribute to high success rates with endoscopic dacryocystorhinostomy.

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Management of acquired nasolacrimal duct obstruction: external and endonasal dacryocystorhinostomy. Is there a third way?

Cited by 10 publications

References 23 publications

Impact of Endoscopic Dacryocystorhinostomy on Sinonasal Quality of Life

Impact of Endoscopic Dacryocystorhinostomy on Sinonasal Quality of Life

Outcomes of external and endonasal dacryocystorhinostomy according to a modified Lacrimal Symptom Questionnaire (Lac-Q)

Use of an image-guided navigation system for routine endonasal endoscopic dacryocystorhinostomy

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