A Modified Preserved Nasal and Lacrimal Flap Technique in Endoscopic Dacryocystorhinostomy

Wenyan Peng,Xuanwei Liang,Bowei Tan,Zhonghao Wang,Haiying Wang,Yandong Wang

doi:10.1038/s41598-017-07364-9

Abstract

Here we describe a modified preserved nasal and lacrimal mucosal flap technique in endonasal endoscopic dacryocystorhinostomy (EES-DCR) for patients with epiphora secondary to primary acquired nasolacrimal duct obstruction (PANDO) and evaluate its outcomes. Twenty-five patients with PANDO were retrospectively reviewed. Modified preserved nasal and lacrimal mucosal flap technique in EES-DCR was applied in all 27 eyes of 25 patients. The patients were evaluated with objective (anatomical patency) and subjective (symptomatic cure) success rates within the duration of follow-up. In the present study, all of the patients’ surgical procedures were successful. There were 2 cases of flap dislocation from the rhinostomy site 1 week post-operation. After a mean follow-up of 4.9 ± 1.8 months, the success rate of anatomical patency was 100% (27/27) and the success rate of symptomatic cure was 92.6% (25/27). No significant complications occurred intraoperatively. We concluded that the modified preserved nasal and lacrimal mucosal flap technique in EES-DCR for treating PANDO is simple and safe, can effectively cover the bare bone around the opened sac, and provide a similar or even better clinical outcome compared with other routine treatment techniques used for this condition.

Highlights

How to create a large bony ostium and minimize postoperative scarring, stenosis, and maintain sustained patency of the ostium is of key importance in performing endonasal endoscopic dacryocystorhinostomy (EES-DCR)
The success rate of EES-DCR reported in the literature ranges from 79.4% to 96%10, 14–17
Durvasula and Gatland reported that the formation of granulation tissue may be caused by the bare bone[25]

Summary

Introduction

How to create a large bony ostium and minimize postoperative scarring, stenosis, and maintain sustained patency of the ostium is of key importance in performing EES-DCR. We report a modified technique to create nasal and lacrimal mucosal flaps in EES-DCR procedure. We made two horizontal relaxing incisions at both ends to form a door “]” shape sac mucosal flap which was intended as the posterior edge of the bony ostium (J flap) (Fig. 2E).

Results

Conclusion