Surgical outcomes in acute dacryocystitis patients undergoing endonasal endoscopic dacryocystorhinostomy with or without silicone tube intubation

Abstract

Aim: To establish the necessity of silicone tube intubation in acute dacryocystitis (AD) patients undergoing endonasal endoscopic dacryocystorhinostomy (En-DCR).

Methods: Patients presenting with unilateral AD were randomly assigned to two treatment groups. En-DCR procedures were performed following lacrimal abscess formation, with the operation being performed with silicone intubation for patients in group B but not group A. Functional success was defined by an absence of additional AD episodes, no epiphora, and ostium patency as established via endoscopic evaluation or fluorescein irrigation. Operative success rates and demographic variables were compared between treatment groups.

Results: In total, 66 patients were analyzed in the present study (33 per group), with complete postoperative data having been successfully collected from 27 and 22 patients in group A and group B, respectively. All patients exhibited complete resolution of acute inflammation. Upon follow-up, granulation tissue was detected around the ostium at higher rates in group B (9/22, 40.9%) relative to group A (4/27, 14.8%). At the 12-month follow-up time point, patients in group A exhibited higher success rates (25/27, 92.6%) relative to patients in group B (20/22, 90.9%), but this difference was not significant. Cases of lacrimal passage reconstruction failure in both groups were attributed to excessive fibrous and/or granulation tissue formation proximal to the intranasal ostium.

Conclusion: Given that these two operative approaches are associated with similar rates of operative success and in light of differences in granulation tissue formation, cost, and operative duration, these data do not support the routine silicone intubation of AD patients following En-DCR surgery.

Keywords: En-DCR; acute dacryocystitis; granulation; silicone tube.

Figure 1. Depicts the steps of the surgical methods

A: A blade was used to incise the lateral nasal mucosa wall proximal to the lacrimal sac fossa; B: A power burr was used to thin the maxilla and frontal process of the maxilla; C: Maxilla was removed with a Kerrison rongeur; D: An ultrasharp 9# MVR knife was utilized to anteriorly incise a portion of the lacrimal sac in order to release the purulent material from the abscess; E: The sac was fully opened with the knife, and a nasalmucosal flap was trimmed and positioned such that it covered the exposed maxilla, after which Merogel was packed around the wound; F: Patients in group B had a bicanalicular silicone tube inserted into the ostium from the superior and inferior puncta, with the tube ends being tied together within the nasal cavity.

Figure 2. Granulation tissue around the ostium

A: Granulation tissue around the ostium in group A; B: Granulation tissue around the ostium in group B.

Figure 3. Success cases in each group

A: Ostial patency with an epithelized mucosal layer exhibiting a normal appearance under endonasal endoscopic examination in group A; B: Normal functional endoscopic dye test results in group A; C: Silicone tube placement in the ostium; D: Ostial patency with an epithelized mucosal layer exhibiting a normal appearance under endonasal endoscopic examination in group B.

Figure 4. Failed cases in each group

A: A failed case in group A exhibiting granulation tissues occluding the lacrimal sac ostium; B: Another failed case in group A exhibiting scar synechia occluding the lacrimal sac ostium; C: A failed case in group B exhibiting silicone tube placement in the ostium; D: The same case in group B exhibiting ostium closure at 9mo following tube removal.

Figure 5. A low-suction cutting instrument utilized to excise granulation tissues from patients in which they had formed following En-DCR

The cutting edge and aspiration port are respectively marked by white and black arrows.