Study of the effect of different designs of nasal mucosal and lacrimal sac flaps on the success rate of external dacryocystorhinostomy

Abstract

Purpose The aim of this study was to assess the effect of the designing of four types of mucosal flaps on the success rates of dacryocystorhinostomy. Patients and methods In this prospective randomized study, dacryocystorhinostomy was performed for 128 eyes with nasolacrimal duct obstruction in adults complaining of epiphora. Patients were subdivided into four groups: group 1included 32 eyes in which only anterior flaps were sutured; group 2 included 32 eyes in which anterior flaps were sutured together with excision of posterior flaps; group 3 included 32 eyes in which anterior and posterior flaps were sutured; and group 4 included 32 eyes in which no flaps were created. Patients of all groups were followed up for 6 months. Assessment of operative success depended on subjective patient satisfaction − that is, stoppage or reduction in epiphora. Objective patency of fistula was assessed by means of positive syringing and estimating the area of the fistula using ultrasound. All data of four groups were statistically compared to assess significance. Results The success rate in group 1 was 100% in the first week, 100% after 1 month, and 93.8% after 6 months. The success rate in groups 2 and 3 was 100% in the first week, 100% after 1 month, and 96.8% after 6 months. There was no statistical significance for this disparity. The success rate in group 4 was 87.5% in the first week owing to fibrosis, 81.2% after 1 month, and 65.6% after 6 months. Using B-mode ultrasonography, the mean osteotomy area was 400mm2 intraoperatively for all cases, 337.4 mm2 (84.3% of intraoperative size) for the successful cases on the second postoperative day, and 32.2 mm2 (8% of intraoperative size) 6 months after the operation. Osteotomy size in unsuccessful cases was 237 mm2 (59.2% of intraoperative size) on the second postoperative day and 3.3 mm2 (0.8% of intraoperative size) 6 months after the operation. Conclusion Suturing of anterior suspended flaps in daryocystorhinostomies increases the success rate as in groups 1, 2, and 3. The difference between suturing, removing, or leaving the posterior flaps was found statistically nonsignificant. Thus, it can be judged intraoperatively according to its redundancy, ease of access, and operation time. It is not recommended to remove anterior and posterior flaps as this decreases the success rate significantly. The use of B-mode ultrasonography for follow-up of the osteotomy size postoperatively is recommended as a safe, effective, and noninvasive procedure.