Powered Endoscopic Dacryocystorhinostomy

Abstract

Powered endoscopic DCR is a safe procedure and offers excellent results both in primary and revision DCRs. The threshold to perform adjunctive endonasal procedures should be very low when indicated.

Time taken for superior osteotomy in primary powered endoscopic dacryocystorhinostomy: is there a difference between an ultrasonic aspirator and a mechanical burr?

“…Patients were chosen alternatively into each group; odd-numbered patients were assigned to the mechanical burr group and even-numbered patients were assigned to the piezoelectric or ultrasonic group. The surgery was performed as per standard protocols as described, [1][2][3][4] and all patients were operated on by a single surgeon (M.J.A. ), who was equally experienced with both the instruments.…”

“…[2][3][4] The specifics with regard to superior osteotomy are described here. Following elevation of the mucosal flap off the lateral wall, the frontal process of maxilla and its junction with lacrimal bone are exposed.…”

“…[1][2][3][4] The key steps for a successful outcome are creation of an ostium large enough to completely expose the entire length of the lacrimal sac, full-length sac marsupialization, and complete mucosa to mucosa approximation to encourage healing by primary intention. [1][2][3][4] Superior osteotomy is an important step to achieve full exposure of the sac, and various modalities have been employed to achieve this, including use of chisel and mallet, special bone nibblers, lasers, mechanical burrs, and ultrasonic emulsification.…”

“…[1][2][3][4] The key steps for a successful outcome are creation of an ostium large enough to completely expose the entire length of the lacrimal sac, full-length sac marsupialization, and complete mucosa to mucosa approximation to encourage healing by primary intention. [1][2][3][4] Superior osteotomy is an important step to achieve full exposure of the sac, and various modalities have been employed to achieve this, including use of chisel and mallet, special bone nibblers, lasers, mechanical burrs, and ultrasonic emulsification. 2,[5][6][7][8] Mechanical burrs are popular and commonly used for quick removal of the superior bone; however, ultrasonic emulsification is fast emerging as an alternative and safe powered instrument, although there is limited data on the surgical outcomes using the ultrasonic instruments.…”

“…[1][2][3][4] Superior osteotomy is an important step to achieve full exposure of the sac, and various modalities have been employed to achieve this, including use of chisel and mallet, special bone nibblers, lasers, mechanical burrs, and ultrasonic emulsification. 2,[5][6][7][8] Mechanical burrs are popular and commonly used for quick removal of the superior bone; however, ultrasonic emulsification is fast emerging as an alternative and safe powered instrument, although there is limited data on the surgical outcomes using the ultrasonic instruments. 6,[8][9][10] Few studies in the past have looked at the time taken for a DCR using different approaches and techniques and it has become obvious that the time taken is influenced by the experience of the surgeon and the number of steps involved, which may vary with different approaches.…”