Endoscopic dacryocystorhinostomy: modified technique

Abstract

Background: Dacryocystorhinostomy (DCR) is a surgical technique that has been increasingly used by otolaryngologists in recent years due to the improved endonasal approach with endoscopes. Although it was first described in 1893 by Caldwell, it has been performed by ophthalmologists.

Objectives: Even though permeability results are similar in long-term follow-up, we present some modifications that in our opinion contribute to the improvement of the results and the simplification of the surgical technique: mucosal flap design that helps to improve the postoperative mucosal recovery, careful dissection of the bony suture between the frontal process of the maxillary bone and the lacrimal bone, and osteotomy using a Smith-Kerrison forceps.

Study design and setting: Two groups are compared. In the first group (96 DCRs), patients underwent chisel osteotomies without a mucosal flap of the lacrimal duct, and in the second group (40 DCRs), the modified technique was applied.

Results: Final permeability results are similar (92.7% versus 87.5%). No major complications were found, and the most common minor complication was postoperative eyelid hematoma in cases where orbital fat was exposed (5 cases versus 7 cases).

Conclusions: There are no differences in final results, but the modified technique is easier to perform, improves postoperative mucosal recovery, is more functional and less aggressive, and improves the cost-benefit ratio.