Outcomes after endoscopic DCR without mucosal flap preservation

Department of Otolaryngology-Head and Neck Surgery, University of Colorado Health Sciences Center, Denver, Colorado, USA.
American Journal of Rhinology (Impact Factor: 1.36). 11/2007; 21(6):753-7. DOI: 10.2500/ajr.2007.21.3095
Source: PubMed


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.

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    • "CT scan is mandatory to show the anatomy and the variations of key structures such as the agger nasi and the uncinate process (Figs 1, 3) 19. The success rate of the endonasal endoscopic approach, as reported in recent studies, is between 58% and 97%, which are lower than rates with external DCR (75- 99%) 7 12 13 15. The most common cause of surgical failure in the former approach is a rhino-stomal stenosis 13. "
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    ABSTRACT: The purpose of this study is to evaluate the effectiveness of endoscopic dacryocystorhinostomy by the posterior lacrimal sac approach without use of lacrimal stents or harvest of mucosal flaps as a valid surgical procedure for the treatment of an obstruction of the lacrimal pathways. A retrospective evaluation was conducted in a cohort of 75 patients between 2007 and 2011. A total of 78 endoscopic dacryocystorhinostomies were analyzed in 75 patients. After a mean follow-up of 25.7 months (minimum 12 months), 93.3% had a complete relief of symptoms after surgery. Our experience appears to confirm that the endoscopic posterior lacrimal sac approach with no stent insertion or mucosal flaps creation is a good alternative to other known endoscopic procedures.
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    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.
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