Comparative Study of Endonasal Endoscopic Dacryocystorhinostomy with or without Preservation of Nasal Mucosal Flap

Abstract

Objective: To analyse the result of endoscopic endonasal dacryocystrhinostomy with or without preservation of nasal mucosal flap.

Study design: Randomised prospective cohort design.

Setting: Tertiary academic centre.

Subjects and methods: 100 patients who presented with epiphora and diagnosed as chronic dacryocystitis after syringing by ophthalmologist, were selected and randomised into two groups. Standard surgical procedure of endoscopic endonasal dacryocystorhinostomy was carried out except for the preservation of flap in group A and without preservation of flap in group B. Additional surgeries were done according to necessity. Postoperatively, patients were followed up on OPD-basis at the end of 1^st week, 2^nd week, 1^st month, and 3^rd month. Symptomatic improvement was assessed and patency checked by syringing by the ophthalmologist.

Results: Nil intraoperative complications (p < 0.05) and nil postoperative complication noted (p < 0.05). Functional and anatomical patency found to be 100% at the end of 1^st week in both groups, 96% at 3^rd month in case group A and 98%, 92% and 82% respectively at the end of 2^nd week, 1^st month and 3^rd month in group B. Nasal endoscopy of all surgical failures showed restenosis in both groups and synechiae in 2 patients in group B.

Conclusions: Preservation of nasal mucosal flap with modification around stoma can be used to cover the bared bone with avoidance of granulation tissue formation reducing the risk of closure of ostium with large rhinostomy and improve success of endoscopic endonasal DCR.

Keywords: Dacryocystorhinostomy.

Fig. 1

Incision over mucosa with cautery

Fig. 2

Frontal process of maxilla after inferiorly based flap creation

Fig. 3

Medial wall incised with keratome