A Modified Preserved Nasal and Lacrimal Flap Technique in Endoscopic Dacryocystorhinostomy

Abstract

Here we describe a modified preserved nasal and lacrimal mucosal flap technique in endonasal endoscopic dacryocystorhinostomy (EES-DCR) for patients with epiphora secondary to primary acquired nasolacrimal duct obstruction (PANDO) and evaluate its outcomes. Twenty-five patients with PANDO were retrospectively reviewed. Modified preserved nasal and lacrimal mucosal flap technique in EES-DCR was applied in all 27 eyes of 25 patients. The patients were evaluated with objective (anatomical patency) and subjective (symptomatic cure) success rates within the duration of follow-up. In the present study, all of the patients' surgical procedures were successful. There were 2 cases of flap dislocation from the rhinostomy site 1 week post-operation. After a mean follow-up of 4.9 ± 1.8 months, the success rate of anatomical patency was 100% (27/27) and the success rate of symptomatic cure was 92.6% (25/27). No significant complications occurred intraoperatively. We concluded that the modified preserved nasal and lacrimal mucosal flap technique in EES-DCR for treating PANDO is simple and safe, can effectively cover the bare bone around the opened sac, and provide a similar or even better clinical outcome compared with other routine treatment techniques used for this condition.

Figure 1

A Modified Preserved nasal and lacrimal mucosal flap Technique in Endoscopic Dacryocystorhinostomy. (A and B) Localization of nasal mucosal flap. (C) Open bony ostium, and expose lacrimal sac. (D) The 23-gauge laser light trans-illuminates and tents up the medial sac wall to confirm the surgical position in the lacrimal wall.

Figure 2

A Modified Preserved nasal and lacrimal mucosal flap Technique in Endoscopic Dacryocystorhinostomy. (E) Localization of the lacrimal sac flap incisions. (F and G) Lift up lacrimal sac flap, Silicone tubes are placed through lacrimal punctum after lacrimal flap is everted. (H) Mucosal flaps cover posterior, superior, anterior and inferior edge of the exposed bony ostium surface. Note the position of the expansive sponge, to maintain a patent ostium.