Endonasal dacryocystorhinostomy using mucosal flaps

Abstract

Objectives: The introduction of endoscopes has led to a great interest in endonasal dacryocystorhinostomy (DCR). External DCR remains the gold standard with success rates of 90%+ reported. The authors carried out 100 consecutive endoscopic DCRs. The technique was then changed to incorporate mucosal flaps to create a terminal DCR, as described by Lun Sham and Wormald. The results were analyzed to assess if the change in technique altered the patency rates. Methods: The technique for endonasal endoscopic DCR is described. The technique for creating nasal mucosal flaps used has not been described before and is a modification of techniques described previously. The results of 100 consecutive patients undergoing endoscopic DCRs performed between September 1998 and November 2001 were analyzed. This constituted 103 DCRs. The technique was then modified to include the fashioning of mucosal flaps as described later. The results of 50 DCRs in 45 patients was analyzed for stomal patency and eradication of symptoms. All procedures were preformed by one surgeon (TJR). Results: The second cohort of patients in whom mucosal flaps were created had a greater success rate and stomal patency rate than the first cohort. Conclusions: The technique for using mucosal flaps of nasal mucosa and lacrimal sac is associated with higher success rates and stomal patency. The authors suggest that the creation of mucosal flaps is extremely important in maintaining high success rates that are comparable with those for external DCR.