Conjunctivocystorhinostomy with Jones tube--is it the surgery for children?

Abstract

Background: To present experience with conjunctivocystorhinostomies (CDCR) at pediatric age.

Methods: Operative and postoperative data were collected for 15 pediatric CDCRs (aged 9 to 14.5 years) performed endonasally. Four procedures were performed bilaterally, seven unilaterally. The follow-up examinations were made every 3 months in the first year, every 6 months in the second year, and every 12 months afterwards. The patient s satisfaction with the surgery, lacrimal drainage function, and complications were evaluated. The drainage function of the lacrimal system was assessed on the basis of the history, clinical examinations, and the fluorescein dye disappearance test. The data were taken from the medical records and written questionnaires.

Results: After the surgery, 12 children were very satisfied, two children partially satisfied, and one child was not satisfied (due to the loss of the tube). Full or partial functional success was found in 14 cases (93.3%); no functional success was observed in one case. The number of complications was higher than in other studies concerning adult patients. A total of 37 complications were observed in our study; most of the complications occurred in more than one of the children, and were observed in some children several times. The most frequent complications were lateral or medial malposition (25 times) and the extrusion of the tube (eight times). It was necessary to re-insert the tube in seven cases under general anaesthesia. The complications mostly occurred within the first 3 months after the surgery (seven complications during the first week, 12 complications between the 2nd and the 4th week, eight complications between the 5th and the 12th week, and three complications between the 9th and the 12th postoperative week).

Conclusions: CDCR appears to be a reasonable procedure in children over 10 years old. Experience in lacrimal surgery (pediatric dacryocystorhinostomy, CDCR in adults), and good cooperation and compliance of children are a fundamental assumption for successful pediatric CDCR.