Prevention of re-obstruction in watery eye treatment: three-flap technique in external dacryocystorhinostomy

Kakizaki, Hirohiko; Kitaguchi, Yoshiyuki; Takahashi, Yasuhiro; Mupas-Uy, Jacqueline; Mito, Hidenori

doi:10.1007/s00417-016-3490-z

Cited by 10 publications

(10 citation statements)

References 21 publications

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“…In addition, the 8-flap ex-DCR surgery was quite time-consuming, with an average surgical time of 120 minutes. Kakizaki et al [10] performed an ex-DCR with a 3-flap technique in 70 eyes of 61 patients, reporting a functional success rate of 94.3 % with the formation of granulation tissue in the anterior part of 2 eyes. In this technique, superior, inferior, and anterior flaps were formed by making a vertical H-shaped incision in the lacrimal sac and a horizontal U-shaped incision in the nasal mucosa.…”

Section: Discussionmentioning

confidence: 99%

“…Since the created flap configuration is considered to be one of the most important factors that increase surgical success and prevent a recurrence, many studies have been conducted on different flap configurations 3 , 4 , 16 , 17 , 18 , 19 . In a study conducted on the etiology of recurrence after DCR 10 , no-flap en-DCR was applied to 53 eyes of 37 patients. In the postoperative period, granulation tissue was reported to form on the anterior part in 35 eyes (66%), on the superior part in 18 eyes (34%), on the inferior part in 9 eyes (17%), and the posterior part in 1 eye (1.9%).…”

Section: Discussionmentioning

confidence: 99%

“…In the most common variations of the DCR surgery, such as the endonasal approach without mucosal flap (no flap en-DCR) as well as the anterior and posterior flap anastomosis (ex-DCR), the exposure of the bone marrow in the areas of the osteotomy site that are not covered with mucosa obstructs the passage and leads to recurrence of the problem. This is because granulation tissue is formed in the areas uncovered with mucosa 1 , 10 . Hence, for a successful DCR, the bone ostium should have a sufficient clearance, and mucosal continuity in the anastomosis line should be in the correct anatomical and physiological configuration 5 , 11 .…”

Section: Introductionmentioning

confidence: 99%

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Fusiform Anastomosis Technique with a Single Longitudinal Incision in the Lacrimal Sac in External Dacryocystorhinostomy

Uçar¹,

Tezel

2022

Klin Monbl Augenheilkd

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Background In the present study, we aimed to evaluate the surgical outcomes of the fusiform anastomosis technique in external dacryocystorhinostomy (ex-DCR) that we designed in the form of a physiological tube, which sufficiently covered the bone ostium with the mucosa. Material and Methods This was a retrospective observational study that included 145 eyes of 131 patients who underwent ex-DCR due to nasolacrimal duct obstruction. The patients were divided into two groups. Group 1 included 73 eyes of 65 patients who underwent fusiform anastomosis, and group 2 included 72 eyes of 66 patients who underwent conventional anterior and posterior flap anastomosis. The open nasolacrimal passage with lacrimal irrigation and the absence of reflux were accepted as anatomical success, and the absence of epiphora symptoms was accepted as functional success. The groups were compared in terms of anatomical success, functional success, and granulation tissue formation. Results Anatomical success was observed in 73 eyes (100%) in group 1 and 66 eyes (91.6%) in group 2 (p = 0.01). Functional success was observed in 72 of 73 eyes (98.6%) in group 1 and 65 of 72 eyes (90.2%) in group 2 (p = 0.02). Nasal endoscopic examination performed in 32 eyes in group 1 and 28 eyes in group 2 revealed that granulation tissue was observed in 7 of 28 eyes (25%) in group 2, while there were no eyes with granulation tissue in group 1 (p = 0.01). Conclusion The fusiform anastomosis technique in ex-DCR provided excellent anatomical success and extremely good functional success.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fusiform Anastomosis Technique with a Single Longitudinal Incision in the Lacrimal Sac in External Dacryocystorhinostomy

Uçar¹,

Tezel

2022

Klin Monbl Augenheilkd

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“…The packing gauze swallowed by the patient was placed in the middle meatus, close to the throat. Whereas, the main surgical field of the en-DCR is just anterior to the middle concha [ 1 , 3 , 6 ]. The gauze was left, therefore, out of the view during the surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The same packing gauze was also used for hemostasis during the surgery. The osteotomy was performed using an ultrasonic bone curette (Sonopet ® ; Stryker, Kalamazoo, MI, USA) [ 3 ]. The patient was instructed to spit out the irrigated fluid as needed.…”

Section: Case Reportmentioning

confidence: 99%

Accidental Ingestion of Nasal Packing Gauze during Endonasal Endoscopic Dacryocystorhinostomy under Local Anesthesia: A Case Report

Kitaguchi¹,

Mupas-Uy²,

Takahashi³

et al. 2017

Case Rep Ophthalmol

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Purpose: To report a case of accidental ingestion of a nasal packing gauze during endonasal endoscopic dacryocystorhinostomy (en-DCR) under local anesthesia. Case Report: A 66-year-old female patient underwent an en-DCR for a right acquired nasolacrimal duct obstruction. The surgery was performed in a supine position under local anesthesia. An X-ray detectable ribbon gauze soaked in 0.02% epinephrine was placed in the middle meatus to prevent blood and liquid from flowing into the pharynx. The same packing gauze was also used for hemostasis during the surgery. At the end of the surgery, 1 piece of gauze was missing and could not be detected by the endonasal endoscopic exploration. An abdominal X-ray image performed on the same day demonstrated the presence of the gauze in the stomach although the patient did not notice swallowing the gauze. The gauze was not there on the X-ray 1 week later. Conclusion: Surgeons need to be aware of accidental ingestion of a nasal packing gauze in en-DCR under local anesthesia. Keeping the gauze end out of the nostril is likely preventive for this complication. The use of X-ray detectable gauze was helpful to detect its location.

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Primary External Dacryocystorhinostomy

Ali¹

2017

Principles and Practice of Lacrimal Surgery

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Prevention of re-obstruction in watery eye treatment: three-flap technique in external dacryocystorhinostomy

Abstract: The 3-flap ex-DCR did not cause recurrent nasolacrimal duct obstruction, rendering it a very useful technique in terms of quality of life and medical economics.

Cited by 10 publications

References 21 publications

Fusiform Anastomosis Technique with a Single Longitudinal Incision in the Lacrimal Sac in External Dacryocystorhinostomy

Fusiform Anastomosis Technique with a Single Longitudinal Incision in the Lacrimal Sac in External Dacryocystorhinostomy

Accidental Ingestion of Nasal Packing Gauze during Endonasal Endoscopic Dacryocystorhinostomy under Local Anesthesia: A Case Report

Primary External Dacryocystorhinostomy

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