Keywords : dacryocystorhinostomy

Outcome of Endonasal Endoscopic Dacryocystorhinostomy in Nasolacrimal Duct Obstruction

Ali A.Abdalwahid; Ragheed T. Miteab; Hussein J. Mohsin

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 3, Pages 344-354

Dacryocystorhinostomy (dcr) is the standard trcatmert for nasolacrimal duct Obstruction .based on opening the lacrimal sac, which is connected to the nose, by removing the bone and the mucosa between these two structures at the level of the middle meatus.
To highlight the procedure of endonasal endoscopic dacryocystorhinostomy.
This was a prospective study conducted at Ghazy Al- hariri teaching hospital for surgical specialties during the period from 22nd of February 2011to the 4th of March 2013. A total of 22 patients were referred from the ophthalmologist for endoscopic dacryocystorhinostomy after had been diagnosed as distal obstruction of nasolacrimal duct or sac. Data were collected and all patients were investigated with general pre-operative investigation in addition to CT scanning to exclude any associated abnormalities or neoplasm and rigid nasal endoscopy were performed for all patients. Intranasal decongestant and steroids along with oral antibiotic were given pre-operatively in 14 patients. Endoscopic dacryocystorhinostomy was performed; the patients were followed up for 6 months and evaluated regularly for any complication.
The mean age of the patients was (32.9 ± 12.7) years with range of (12– 69) years. About 59% of the patients aged 21-40 years. Females were predominant with a female to male ratio of 3.4:1. All patients had mucopurulant conjunctival discharge. The median duration of presentation was 5-6 months. The DCR performed eleven in right side and eleven in left side, and 4 associated operation were conducted for management of associated abnormalities. Eight complications developed during different time of follow up and only one patient needed re insertion giving a success rate of 95.5%.
The endoscopic endonasal DCR is a safe procedure for the treatment of nasolacrimal duct obstruction and with high success rate and less serious complications.

Endoscopic Endonasal Dacryocystorhinostomy Versus External Dacryocystorhinostomy

Najah K.M.Al-Quriashi; Safa Noury M. Ali; Qasim K. Farhood

Iraqi Postgraduate Medical Journal, 2011, Volume 10, Issue 2, Pages 214-219

Epiphora and recurrent dacryocystitis are common problems between adult patients consulting ophthalmic and ENT departments. They are occur mostly duo to obstruction of nasolacrimal duct for different causes. Surgical treatment is the only available way to treat them.
To study the clinical outcomes of a new endoscopic endonasal dacryocystorhinostomy (EENDCR) technique compared to the conventional external Dacryocystorhinostomy technique (Ext-DCR).
A retrospective, comparative cross sectional study on 105 cases with epiphora operated upon in 5 years (2004-2009), 60 consecutive EENDCRs and 45 Ext-DCRs. Patients with anatomic nasolacrimal duct obstruction were included in the study; previous lacrimal surgery, functional nasolacrimal, canalicular obstruction and nasal problems were excluded. Two surgeons performed the EENDCRs, using a standardized operative technique, which involved creation of a large bony ostium and mucosal flaps between the lacrimal sac mucosa and nasal mucosa. One surgeon performed all Ext-DCRs.
53 patients (15 men, 38 women) underwent 60 EENDCRs. The average age of the patients was 40 years (range, 5 to 70 years). In the Ext-DCR group, 45 patients (14 men, 31 women) underwent 45 DCRs. The average age was 30.5 years (range, 6 to 49 years). The average follow-up time was 10 months for the EENDCR group and 12.2 months for the Ext-DCR group. Success was defined as relief of symptoms and by anatomic patency, which was assessed by history, fluorescein dye and syringing of lacrimal drainage system. The success rate was significantly higher in cases underwent Ext-DCRs {95.55% (43/45)} as compared to cases underwent EEDCRs {81.66% (49/60)}. (P < 0.05)
CONCLUSIONS: Ext-DCR offers better symptom free outcomes (95.55%) than endoscopic DCR (81.66%). Patients who are more interested than others in cosmetic subject, their operations must be conducted with EENDR. A larger, randomized prospective trial is needed to fully assess the efficacy of this new technique.