Success Rates in Powered Endonasal Revision Surgery for Failed Dacryocystorhinostomy in a Tertiary Referral Center

Abstract

In this study, the most frequent cause of failed DCR was a scarred ostium, which is optimally visualized endonasally and precisely managed with the oscillating blade. Using the abovementioned specific endonasal techniques, the authors have demonstrated a high success rate in endonasal revision DCR surgery.

Endoscopic DCR using bipedicled interlacing mucosal flaps

“…As previously described in literature, the obstruction of the endonasal neo‐ostium by cicatricial stenosis with membranous obstruction, synechiae, and/or granuloma formation remains the most common reason for failed eDCR (51%–86%) . An additional significant cause of failure is inappropriate placement of the neo‐ostium or subtotal bone removal over the lacrimal sac .…”

“…1,2,4,5 As previously described in literature, the obstruction of the endonasal neo-ostium by cicatricial stenosis with membranous obstruction, synechiae, and/or granuloma formation remains the most common reason for failed eDCR (51%-86%). [6][7][8] An additional significant cause of failure is inappropriate placement of the neo-ostium or subtotal bone removal over the lacrimal sac. 3,9,10 Our surgical technique provides for safe and reproducible identification of the lacrimal sac, which ensures appropriate placement of the neo-ostium.…”

Long‐term outcomes in revision powered endoscopic dacryocystorhinostomy

“…Common endoscopic findings in failed cases are cicatricial ostium closures, scarred common canaliculus, obstructed distal canaliculi, organizing granulomas, and bone neogenesis . Reported success rates for revision DCR are typically quoted as being lower than for primary DCR, with success rates ranging from 85% to 94% in external DCR, 83% to 94% in endonasal DCR, and 67% to 83% in endocanalicular laser DCR . To the best of the authors’ knowledge, there are no studies on long‐term results of revision powered endoscopic DCR with a strict minimum follow‐up of 12 months.…”

Comparison of different surgical methods in endonasal dacryocystorhinostomy

“…[12] Formation of a granulation tissue, adhesions, septal deviation, incomplete excision of the bony scaffold of the lacrimal sac, canalicular obstruction and inappropriate location of the de novo ostium can be considered among other reasons of procedure failure. [5] In external DCR procedure, since anatomy of the nasal cavity could not be evaluated fully, agger nasi cells, anterior ethmoidal cell variations and nasal septum deviation can be overlooked.…”