Results of nonendoscopic endonasal dacryocystorhinostomy

Abstract

BackgroundSurgical scarring on the face and disrupted anatomy in the medial canthal area following external dacryocystorhinostomy (DCR) can be avoided by an endonasal approach. This study examined the outcome of direct visualization endonasal DCR, performed by young surgeons and residents.MethodsA retrospective case series of 75 consecutive endonasal DCRs performed under direct visualization from July 2002 to July 2004 were reviewed. Surgery was performed by surgeons and residents who had received no special training in the procedure. Full success was defined as no symptoms of tearing after surgery and anatomical patency with fluorescein flow on nasal endoscopy or patency to lacrimal syringing. Partial success was defined as a tearing decrease compared with prior to surgery and with anatomical patency, and failure was defined as no significant improvement in persistent tearing. The average follow-up duration was 26.83 ± 16.26 (range 6–55) months.ResultsSeventy-five DCRs were performed on 63 patients (four male, 59 female) of mean age 49.44 ± 16.63 (range 21–85) years. The surgery was successful in 54/75 eyes (72%), 37/54 eyes (68.5%), and 30/42 eyes (71.4%) at 6, 12, and 24 months, respectively. Partial success was achieved in 13/75 (17.3%), 9/54 (16.7%), and 9/42 (21.4%), and the failure rates were 10.7%, 14.8%, and 7.1% at 6, 12, and 24 months, respectively. The overall functional success with this technique was 74.7% and the overall anatomical patency was 92.0%. There were no serious complications arising from the surgery; three minor complications were documented, ie, an incorrectly placed silicone tube in the lower canaliculus, tube prolapse, and postoperative bleeding which needed nasal packing and eventually a developed retention cyst in the nasal cavity.ConclusionEndonasal DCR under direct visualization is a simple technique with minimal complications and a low learning curve, without the necessity for expensive instruments.

Comparison of endonasal dacryocystorhinostomy (DCR) versus endocanalicular diode laser DCR for the treatment of nasolacrimal duct obstruction

“…[1] Varying results have been reported for endoscopic DCR; however, Onerci et al [21] indicated that the surgical success rate of endoscopic DCR in the hands of experienced surgeons was 94.4%, whereas inexperienced surgeons had a success rate of only 58 percent. [2] Many factors influence the success or failure of DCR. Regarding improved surgical success, the size and location of the osteotomy is important.…”

“…[22] Additionally, mitomycin C has been reported to delay wound healing or prevent scarring at the ostial opening. [2] Furthermore, the distal canalicular membranous obstruction is an anatomic factor that may lead to surgical failure if not identified and excised and in these cases, an external DCR procedure combined with membranectomy performed through the distal canalicular opening is recommended. [23] Laser-assisted DCR is an alternative to the standard external DCR.…”

“…Dacryocystorhinostomy (DCR) is the treatment for nasolacrimal duct obstruction and can be performed externally or endonasally. [1] External DCR which was first described by Toti in 1904 [2] is performed with a success rate of 82-99 percent. [3] Fewer complications, such as cutaneous necrosis, cerebrospinal fluid leakage, maxillary and frontal sinusitis, retrobulbar hemorrhage, transient lagophthalmos and subcutaneous emphysema have been reported with this procedure [4,5] However, this lengthy surgical procedure has many disadvantages, such as external skin incisional scarring, excessive intraoperative bleeding, disruption of the medial canthus anatomy and high morbidity associated with trauma to the anterior ethmoid, middle turbinate and nasal septum.…”

“…[3] Fewer complications, such as cutaneous necrosis, cerebrospinal fluid leakage, maxillary and frontal sinusitis, retrobulbar hemorrhage, transient lagophthalmos and subcutaneous emphysema have been reported with this procedure [4,5] However, this lengthy surgical procedure has many disadvantages, such as external skin incisional scarring, excessive intraoperative bleeding, disruption of the medial canthus anatomy and high morbidity associated with trauma to the anterior ethmoid, middle turbinate and nasal septum. [3,6] The endonasal approach was first attempted in 1893 by Caldwell, [2] which evolved into nasal endoscopy in the 1990s. With the development of modern nasal endoscopy, many techniques, most widely endonasal approach, have been used in endoscopic DCR.…”

“…Bone removal can be achieved using the surgical drill, diamond-blurring, rongeur, hammer-chisel, radiofrequency or laser-assisted ablation. [2] An endocanalicular multidiode laser with a 400-600 μm optical fiber, producing a wavelength of 980 nm with a power of 7-20 W was used in this study. It can ablate bone and soft tissues without causing excessive collateral damage.…”