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. 2003 Jan;87(1):43-7.
doi: 10.1136/bjo.87.1.43.

Mechanical endonasal dacryocystorhinostomy with mucosal flaps

A Tsirbas  1 , P J Wormald
Affiliations

Mechanical endonasal dacryocystorhinostomy with mucosal flaps

A Tsirbas et al. Br J Ophthalmol. 2003 Jan.

Abstract

Aims: To describe and assess the efficacy of mechanical endonasal dacryocystorhinostomy (MENDCR). This is a new technique that involves creation of a large rhinostomy and mucosal flaps. The study involved a prospective non-randomised interventional case series with short perioperative follow up.

Method: A prospective series of 104 consecutive endonasal DCRs performed from January 1999 to December 2001 were entered into the study. Patients included in the study had nasolacrimal duct obstruction and had not had previous lacrimal surgery. The technique involved anastomosis of nasal mucosal and lacrimal sac flaps and a large bony ostium. Surgery was performed by two surgeons (AT/PJW). Follow up assessment included nasoendoscopy as well as symptom evaluation. Success was defined as anatomical patency with fluorescein flow on nasoendoscopy and patency to lacrimal syringing. The average follow up time was 9.7 months (range 2-28, SD 6.7 months).

Results: There were 104 DCRs performed on 86 patients (30 male, 56 female). The average age of the patients was 59 years (range 3-89, SD 24.1 years). Common presentations were epiphora (77%) and/or mucocele (19%). Septoplasty (SMR) was required in 48 DCRs (46%) and 13 DCRs (12.5%) needed other endoscopic surgery in conjunction with the lacrimal surgery. The surgery was successful in 93 cases (89%). Of the 11 cases that were classified as a failure six patients was anatomically patent but still symptomatic and another two had preoperative canalicular problems. The anatomical patency with this new technique was thus 95% (99 of 104 DCRs).

Conclusion: MENDCR involves creation of a large ostium and mucosal preservation for the construction of flaps. The anatomical success is 95% and is similar to external DCR and better then other endonasal approaches. The authors suggest that creation of a large ostium as well as mucosal flaps improves the efficacy of this endonasal technique.

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Figures

Figure 1
Figure 1
Mechanical endonasal DCR procedure. (A) A, frontal process of maxilla; B, nasal mucosal flap elevation. (B) Junction of frontal process maxilla and lacrimal bone (arrow). (C) C, lateral nasal wall; black square, punch on frontal process of maxilla. (D) D, lacrimal sac; arrowhead, nasal septum. (E) E, agar nasi cell; arrow, medial wall lacrimal sac, (F) F, opened lacrimal sac; asterisk, folding back of posterior lacrimal sac flap.
Figure 2
Figure 2
Marsupialised lacrimal sac. A, common canalicular opening on lateral nasal wall. B, marsupialised lacrimal sac on lateral nasal wall. C, opened agar nasi cell. D, middle turbinate.
Figure 3
Figure 3
Fluorescein flow into the nose.
See this image and copyright information in PMC

Comment in

References

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