Endoscopic dacryocystorhinostomy to treat congenital nasolacrimal canal dysplasia: a retrospective analysis in 40 children

Abstract

Background: To investigate the therapeutic effectiveness and safety of endoscopic dacryocystorhinostomy (EN-DCR) to treat congenital nasolacrimal canal dysplasia (CNCD).

Methods: Forty children (50 eyes) with congenital nasolacrimal duct obstruction (CNLDO) and lacrimal bony dysplasia, including 8 children with bony atresia (10 eyes) and 32 with bony stenosis (40 eyes), were recruited in this retrospective study. Standardized EN-DCR was performed in all cases. The postoperative observations included relief of symptoms, fluorescein dye disappearance test (FDDT), syringing of lacrimal passages and anastomotic patency under nasal endoscopy. Patients were followed up for 8-18 months.

Results: Standardized EN-DCR surgery had a success (cure and improvement) rate of 100%, including a cure rate of 82% and an improvement rate of 18%. The cure rate among 40 cases of bony nasolacrimal duct stenosis was 82.5%, while that of 10 cases of bony nasolacrimal duct atresia was 80%. Statistical analysis showed that nether the receipt of other treatments before surgery nor the type of bony nasolacrimal duct dysplasia affected the cure rate. No significant complications were observed during postoperative follow-up except for four cases (4 eyes) that suffered middle turbinate and nasal mucosal adhesion and two cases with sinusitis.

Conclusions: CNCD is a type of CNLDO that does not respond to conservative and conventional treatment. EN-DCR represents a safe and effective treatment for children with CNCD. In addition, the combination of EN-DCR with lacrimal CT scanning provides advantages over traditional lacrimal surgery in that it has a high success rate with a low incidence of complications.

Keywords: Children; Congenital nasolacrimal duct obstruction (CNLDO); Endoscopic dacryocystorhinostomy (EN-DCR); Nasal endoscopy; Nasolacrimal canal dysplasia.

Fig. 1

Computed tomography angiography of the lacrimal duct allows congenital nasolacrimal canal dysplasia to be clearly distinguished. (a, b) The sagittal position of bony nasolacrimal duct stenosis (black arrow). (c, d) The horizontal position of bony nasolacrimal duct stenosis (black arrow) and the contralateral contrast (white arrow). (e, f) Both the horizontal and sagittal position show bilateral hypomere bony nasolacrimal duct atresia (black arrow)

Fig. 2

Illustration of the steps of the operation. (a) Remove the frontal process of the maxilla and move the sutura lacrimal maxillaris forward with the rongeur (black arrow). (b) Use an electric drill to grind the thicker parts of the maxilla frontal process upper bone, if needed (black arrow). (c) After producing the bone window, expose the inner wall of the lacrimal sac (black arrow). (d) From the lacrimal point, insert the lacrimal probe into the lacrimal sac (black arrow) after endoscopy has verified accurate exposure of the lacrimal sac (black arrow). (e) A longitudinal incision is made along the lacrimal sac wall, and a crosscut incision is then made at the top and bottom of the initial incision to form a base at the edge of the lacrimal sac wall and form the mucosal flap. Flip the mucosal flap backward to expose the front mucous membrane of the uncinate process, leaving the lacrimal sac cavity completely open (white outline). (f) Blood should be absorbed by stuffing gauze into the lacrimal sac (white arrow), and the lacrimal sac mucosal flap should be pinned to reduce movement and bleeding

Fig. 3

Postoperative anastomotic opening. (a) The anastomotic opening is healing but still shows mild edema at 1 month postoperative (black arrow). (b) The anastomotic opening at 12 months postoperative, with epithelization (white arrow)