'Stenting the Lacrimal System in Modified Denker's for Mucormycosis: Really Needed!'-A Longitudinal Study

Abstract

Introduction: Recent advances in endoscopic paraphernalia have brought the once intricate anterior lateral wall of maxilla, within reach of the endoscopic surgeon. Endoscopic modified Denker's approach provides another route to reach the indiscernible sites of maxillary & other paranasal sinuses along with PPF (pterygo-palatine fossa)/ITF (infra-temporal fossa) region. This approach has been widely used Pan-India during the Post-Covid Mucormycosis Epidemic, in our country. As this approach mandates sacrifice of nasolacrimal duct, the suspicion in some quarters about post-op fibrosis and eventually obstruction of lacrimal drainage is genuine.

Aim: The aim is to understand the legitimate effect of this approach on lacrimal drainage pathway and to determine the need for modification in this approach, like stenting the NLD.

Materials and methods: In total, 100 patients who underwent endoscopic modified Denker's maxillectomy for invasive rhino-orbito-cerebral mucormycosis were included in study. The patency of lacrimal drainage was checked by doing lacrimal sac syringing in each patient. Proportion of patients showing obstruction of lacrimal pathway was calculated.

Result: The ratio of lacrimal obstruction was found to be 9%. Hence, endoscopic modified Denker's approach for lesions involving anteroinferior and anterolateral part of maxillary sinus does not cause significant obstruction in the lacrimal drainage pathway.

Keywords: Endoscopic modified Denker’s approach; Lacrimal sac syringing; Mucormycosis; Nasolacrimal duct.

Fig. 1

Lacrimal drainage pathway (the dotted line showing the level at which NLD is cut)

Fig. 2

Nasolacrimal duct exposed

Fig. 3

Lacrimal cannula with blunt tip and solution used for lacrimal sac syringing