Nonlaser endoscopic endonasal dacryocystorhinostomy with adjunctive mitomycin C in children

Abstract

Purpose: To determine the outcome and safety of pediatric endonasal dacryocystorhinostomy with the use of adjunctive mitomycin C.

Methods: A prospective, nonrandomized and noncomparative interventional case series study was performed in 71 consecutive procedures. Sixty patients 16 years of age and younger underwent nonlaser endonasal dacryocystorhinostomy with the use of adjunctive mitomycin C. Eleven patients had a simultaneous bilateral procedure performed. All patients underwent a standardized procedure, with an endonasal approach to the lacrimal sac and surgical removal of nasal mucosa, lacrimal bone, and a fragment of the frontal process of the maxilla. The medial wall of the lacrimal sac was completely removed and a neurosurgical cottonoid soaked in mitomycin C at 0.5 mg/ml placed at the osteotomy site for 5 minutes. All patients underwent bicanalicular or monocanalicular silicone intubation.

Results: The main outcome measures were the resolution of epiphora, lacrimal discharge, and patency of the ostium confirmed either by endoscopic visualization and/or irrigation at 6 months or a normal dye disappearance test. Thirteen patients' (18%) final evaluation was via telephone survey. The mean follow-up was 12.3 months. Nonlaser endonasal dacryocystorhinostomy with adjunctive mitomycin C was successful in 67 cases (94.4%). African descent was strongly associated with a higher rate of obstruction (p < 0.001). Infection at the time of surgery (p = 0.051) and less than 3 months intubation (p = 0.059) were also borderline significant. Previous trauma, gender, age, and side operated had no influence on the final outcome. No significant complications were encountered.

Conclusions: Nonlaser endonasal dacryocystorhinostomy with mitomycin C is a safe and successful procedure for the treatment of congenital nasolacrimal duct obstruction in children. It has the advantage of leaving no scar and of preserving the medial canthal structures. It can be successfully performed as a simultaneous bilateral procedure.