Outcomes after endoscopic DCR without mucosal flap preservation
ABSTRACT The purpose of this study was to evaluate outcomes of powered endoscopic dacryocystorhinostomy (DCR) without the preservation of mucosal flaps for the management of acquired nasolacrimal duct obstruction.
A retrospective review was performed of patients undergoing endoscopic DCR without mucosal flap preservation from May 2003 to October 2006 at a tertiary referral medical center. Twenty-seven procedures were performed on 20 patients with epiphora secondary to acquired nasolacrimal duct obstruction. Main outcome measures were subjective improvement in epiphora and assessment of anatomic patency based on lacrimal irrigation.
Mean follow-up was 16 months. Mild intermittent postoperative epiphora or complete resolution of epiphora was noted in 100% (27/27) of procedures; complete resolution was recorded in 93% (25/27) of procedures. Eighteen patients (25 procedures) were available for lacrimal irrigation at a mean of 16 months follow-up. Anatomic patency was confirmed in 100% (25/25) of procedures.
Our results with endoscopic DCR are comparable with previously published outcomes. These data suggest that successfully powered DCR may be performed without the preservation of mucosal flaps.
Full-textDOI: · Available from: Todd T Kingdom, Aug 24, 2015
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Article: Endoscopic dacryocystorhinostomy[Show abstract] [Hide abstract]
ABSTRACT: Multiple recent published studies have confirmed the value of the endoscopic dacryocystorhinostomy technique in the treatment of lacrimal obstruction. Significant refinements in technique and instrumentation coupled with an improved understanding of the endoscopic surgical anatomy are largely responsible for the excellent success rates now reported. The advantages of endoscopic dacryocystorhinostomy include the absence of skin incision and scar, preservation of the pump mechanism of the orbicularis oculi muscle, less disruption of medial canthal anatomy, decreased operating time, decreased intraoperative bleeding, and the ability to address concurrently nasal cavity or paranasal sinus abnormalities. Success appears to be dependent on several key aspects: (1) a thorough understanding of the endoscopic anatomy and location of the lacrimal sac, (2) efficient removal of frontal process of maxilla to expose completely the medial wall of the lacrimal sac, and (3) careful incision of the sac to achieve adequate exposure of the common internal punctum. This article describes the authors’ method for performing endoscopic dacryocystorhinostomy.Operative Techniques in Otolaryngology-Head and Neck Surgery 09/2008; 19(3):177-181. DOI:10.1016/j.otot.2008.10.002
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ABSTRACT: The long-term (median follow-up eight years) results of endoscopic dacryocystorhinostomy approach and silicone intubation were evaluated by various aspects. Case series with planned data collection of 38 procedures for postsaccal stenosis were analyzed. Silicone intubation was not used in 19 of the randomly selected procedures. Anatomical and functional surgical success was evaluated subjectively and objectively. The patients' complaints improved in 84.2 percent of eyes in the intubation group, and in 94.7 percent of the group without intubation, with a mean follow-up of 112 and 96 months after surgery, respectively. Postoperative endoscopic examinations revealed that the rhinostomy opening was visible in 17 sides with intubation (89.5%) and 18 sides without intubation (94.7%). Considering the similar surgical success rates, and disadvantageous factors such as granulation formation, patient discomfort, and cost related to intubation, we recommend endoscopic dacryocystorhinostomy without intubation as the treatment of choice in cases of chronic epiphora due to postsaccal stenosis of the lacrimal drainage system.Otolaryngology Head and Neck Surgery 05/2009; 140(4):589-95. DOI:10.1016/j.otohns.2008.12.056 · 1.72 Impact Factor