Abstract
This study aimed to evaluate the necessity for silicone tube insertion following endonasal endoscopic dacryocystorhinostomy (DCR), and the optimal time for its removal. A prospective study was done at Al-sadr Teaching and Al-Shafaa General Hospitals in Basrah, Iraq on seventy two patients with nasolacrimal duct obstruction diagnosed and referred from ophthalmologist to ENT clinic. Preoperative assessment with investigations were done and all patients were subjected to endoscopic endonasal DCR. The patients were divided into three groups; the first group included those with long period stenting (silicone tube removed three months or more), the second group included those patients with short period stenting (tube removed 2-3 weeks after surgery), and the last group included those with no silicone tube stenting. The success rate and complications after surgery were studied in each group for more than one year. The 72 patients were; 63 females (87.5%) who affected more than males (9, 12.5%). the most common age group was 21-45 years. Left side of disease 41(56.9%) is more than right side 31(43.1%). Sixty eight operations (94.4%) out of 72 were primary surgery while four (5.6%) were revision surgery. Ancillary procedures were done also; 13 (18%) septal surgery and 3(4.1%) endoscopic sinus surgery. Success rate was more among short period stenting group 22 out of 24 (91.6%), then without stenting group 19 (82.6%) and those with long period stenting was only 20 from 25 (80%). In conclusion, no statistical significant difference (benefit) about the usage or not of the silicone tube and also about how long keeping the tube, but it is preferable to use silicone tube (for 2-3 weeks only) to improve success rate. Keywords: Silicone tube, Insertion, Endonasal, Endoscopic, Surgery
Highlights
This study aimed to evaluate the necessity for silicone tube insertion following endonasal endoscopic dacryocystorhinostomy (DCR), and the optimal time for its removal
The patients were divided into three groups; the first group included those patients with insertion of DCR silicone tube which was removed after 3 months or more and called long period group, the second group included those patients with insertion of silicone tube which was removed after 2-3 weeks and called short period group, the third group included those patients with no silicone tube insertion
Nasal septal surgery was done in 13 patients as an ancillary procedures while only 3 patients were subjected to endoscopic sinus surgery before DCR at the same session
Summary
This study aimed to evaluate the necessity for silicone tube insertion following endonasal endoscopic dacryocystorhinostomy (DCR), and the optimal time for its removal. The success rate and complications after surgery were studied in each group for more than one year. DIntroduction acryocystorhinostomy (DCR) could be defined as: a surgical bypass of the lacrimal sac and duct that is mainly indicated to treat a patient with epiphora. With the development of endoscopic sinus surgery in the late 1980s, endoscopic DCR become more popular but with lower success rate (6590%) than external procedure, Wormald in the early 1990s described a wide bone removal to expose the entire lacrimal sac to achieve high success rate upto 95%2. Allen etal, identified high failure rate among patients with silicone intubation following DCR6. Lacrimal system consist of secretory system which is composed of lacrimal glands and accessory glands, and an excretory system or drainage pathway which start from upper and lower punctal opening and canaliculi which merge in common canaliculus to enter lacrimal sac (in more than 90% of individuals), the nasolacrimal duct run inferiolaterally and slightly posteriorly to open in the inferior meatus at lateral nasal wall[7]
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