Intranasal Endoscopic Dacryocystorhinostomy Research Articles

The Value of Endoscopic Dacryocystorhinostomy in Management of Acquired Nasolacrimal Duct Obstruction

Background: The epiphora is the most common manifestation of obstruction of the nasolacrimal duct, which is treated by dacryocystorhinostomy either by external or internal endoscopic endonasal approach. With the advance of the nasal endoscope, the endoscopic dacryocystorhinostomy became well established. Aim of the work: To evaluate the efficacy and safety of intranasal endoscopic dacryocystorhinostomy [DCR] in the management of patients with acquired nasolacrimal duct obstruction. Patients and Methods: This is a retrospective study of patients with acquired obstruction of the nasolacrimal duct who underwent intra-nasal endoscopic dacryocystorhinostomy [EDCR] at Al-Azhar University Hospitals from September 2012 to October 2015. Forty-five procedures were done where primary endoscopic DCR was done on forty patients and revision endoscopic DCR was done on failed five patients. The outcome is measured by subjective improvement of epiphora. Results: The patients were followed up for three years, improvement of 35 patients with epiphora from 40 patients [the rate of success was 86.7%] and the remaining five failed cases undergoing revision EDCR with the improvement of four from them. The success was confirmed with the subjective improvement of epiphora. The rate of minor complications reported was 28.8% and managed conservative, and only one major complication occurred in one patient. Conclusion: The endoscopic intranasal DCR is an effective and safe procedure in the management of acquired obstruction of the nasolacrimal duct and gives a high success rate.

Evaluation on the efficacy of modified nasoendoscopic dacryocystorhinostomy

Objective To evaluate the efficacy of modified nasoendoscopic dacryocystorhinostomy for the treatment of chronic dacryocystitis. Methods The data of 48 eyes of 37 patients with chronic dacryocystitis from Mar. 2013 to Jun. 2017 were analyzed retrospectively.All cases were divided into two groups randomly. The control group, 32 eyes of 21 patients were treated with traditional intranasal endoscopic dacryocystorhinostomy; the observed group, 16 eyes of 16 patients were treated with modified nasoendoscopic dacryocystorhinostomy. The efficacy were compared and analyzed between the two groups. Results All the patients were followed up for 6 months.The total effective rate of the control group was 87.5% and 75.0% of the observed group, the difference was not statistically significant between the two groups(P>0.05). Prevension of cicatricial adhesion of anastomosis stoma and little injury and fewer complications were advantages in observed group. Conclusion Modified nasoendoscopic dacryocystorhinostomy is a better surgical method for the treatment of chronic dacryocystitis. Key words: Dacryocystitis, chronic; Dacryocystorhinostomy, nasoendoscopic, modified; Evaluation

Study of Endonasal Endoscopic Dacryo-cystorhinostomy with Special Reference to Mitomycin-C.

The aim of this study was to evaluate long-term results in patients with nasolacrimal duct obstruction treated with intranasal endoscopic dacryo-cystorhinostomy (DCR) with intraoperative topical application of mitomycin-C. The procedure was carried out in 34 subjects (41eyes). Patients with post-saccal stenosis were divided into two groups, 21 patients were treated with intranasal endoscopic dacryo-cystorhinostomy with intraoperative application of Mitomycin-C (MMC) and the other 20 cases underwent procedure only without Mitomycin-C. Effectiveness of drug at rhinostomy site was assessed in relation to granulation formation, adhesions and ostium size. Outcomes were assessed on the basis of relief of subjective symptoms, patency of rhinostomy site confirmed via syringing and final ostium size at end of 6months, 1 and 2year. Success rate was 100% at 3 and 6months follow-up in both the groups. At the end of 1year, one failure was noted in control group which had to undergo revision endoscopic DCR with overall success rate decreasing to 97%. This was maintained at the end of second year. Results revealed that adjunctive use of Mitomycin-C was effective at 3months when granulation tissue formation was significantly lesser in MMC group compared to no MMC group. Topical application of Mitomycin-C has been found to be beneficial in preventing adhesions and also resulted in larger neo-ostium. We concluded that results with intraoperative topical application of Mitomycin-C in endoscopic dacryo-cystorhinostomy are encouraging. It can favourably affect wound healing and result in larger rhinostomy size/ostium. Mitomycin-C is safe and effective adjunct in endoscopic dacryo-cystorhinostomy procedure. Level of evidence Individual prospective cohort study, level 1b.

Endoscopic versus external approach dacryocystorhinostomy: A comparative analysis

Background:Dacryocystorhinostomy (DCR) consists of creating a lacrimal drainage pathway to the nasal cavity to restore permanent drainage of previously obstructed excreting system.Aim:To compare the result and advantages of both endonasal endoscopic and external DCR regarding the patency rate, patient compliance and complications.Study Design:Prospective non-randomized comparative study.Materials and Methods:Study was conducted for 16 months duration in a teaching hospital with 50 cases of endoscopic and 30 cases of external DCR with a follow-up of minimum 6 months. Data regarding surgical outcome and complications were analysed and compared using χ2 test.Results:Total 72 patients were included in the study with six having bilateral involvement, out of which 20 were male and 52 were female. The mean age for endoscopic and external DCR was 33.6 years and 46.0 years, respectively. Right eye (63.8%) was involved more commonly than left eye (36.2%). Epiphora was the commonest presenting symptom (63.7%). Mean duration of surgery was much lengthier in external (mean 119.6 minutes) than endoscopic (mean 49.0 minutes) DCR. Bleeding was the most common immediate postoperative complication seen in 33.3% and 10.0% of external and endoscopic DCR cases, respectively. Primary surgical success rate was 90% and 96.7% for endoscopic and external DCR, respectively (P = 0.046). Among the endoscopic DCR group, four patients underwent revision surgery giving a total successful surgical outcome of 98% at third month of follow-up. However, at 6 month of follow-up, success rate was 92% for endoscopic DCR and 93.3% for external DCR. The difference was not statistically significant (P = 0.609).Conclusion:Intranasal endoscopic DCR is a simple, minimally invasive, day care procedure and had comparable result with conventional external DCR.

Pathologic change after intranasal endoscopic dacryocystorhinostomy with hyaluronate stuffing on rabbits

Objective To investigate the pathological changes in the post-operative lacrimal sac mucosa by intranasal endoscopic dacryocystorhinostomy with hyaluronate (HYAFF,MeroGel) stuffing.Methods 24 rabbits received nasal endoscopic dacryocystorhinostomy were randomly divided into 3 groups.The hyaluronate,gelatin sponge and Vaseline gauze were used respectively for stuffing anastomosis.And two rabbits were normal control.The clinical signs and lacrimal sac mucosa pathological changes were observed in each group by double-blind.Results 3-5 days after operation,clinical reaction and pathological inflammatory reaction were mild in hyaluronate group; In this group,we observed that the hyaluronate dissolved and the anastomotic was covered by epithelia 7 days after operation.The dissolved hyaluronate was absorbed partly 10 days after operation.Conclusion The hyaluronate can reduce the lacrimal sac mucosal inflammation after nasal endoscopic dacryocystorhinostomy,promote incision healing,and dissolve itself gradually. Key words: Nasal endoscopy; Dacryocystorhinostomy; Hyaluronate; Rabbit

Endoscopic Dacryocystorhinostomy Appears to Impair Nasal Mucociliary Clearance

We conducted a prospective study of 50 adults to investigate changes in nasal mucociliary clearance following endoscopic intranasal dacryocystorhinostomy (DCR). Each operation was performed with the use of a drill to perforate the lateral nasal wall in order to reach the lacrimal sac. Each patient's mucociliary clearance time (MCT) was determined by the saccharin test on both the operated and nonoperated sides; the preoperative times were compared with postoperative measurements made 1 and 3 months following DCR. Preoperatively, the mean MCTs were 14.48 minutes on the operated side and 14.50 minutes on the nonoperated side-not a statistically significant difference (p > 0.05). Postoperatively, the corresponding MCTs were 25.22 and 14.98 minutes at 1 month and 18.44 and 15.62 minutes at 3 months. On the operated side, both postoperative MCTs were significantly longer than the preoperative value (p < 0.001), while on the nonoperated side, neither postoperative MCT was significantly different from the preoperative value (p > 0.05). Also, the postoperative MCTs were significantly longer on the operated side than on the nonoperated side at both 1 month (p < 0.001) and 3 months (p < 0.05). Only 1 of the 50 operations was considered to be unsuccessful; the reason for this surgical failure was the patient's ongoing complaints of chronic postoperative dacryocystitis. We conclude that endoscopic DCR disturbs mucociliary clearance. Changes in MCTs may be attributable to injury to the nasal mucosa or to the continuous flow of tears through the nasal mucosa.

Lacrimal dacryostenosis with severe facial pain misdiagnosed as trigeminal neuralgia

A 47-year-old woman developed intermittent shooting pain around the right side of the nose and eyes. A neurologist initially diagnosed trigeminal neuralgia, but carbamazepine did not improve the pain. Two months later, she presented with a pus-like eye discharge and was referred to us for further examination. Poor saline irrigation from the lacrimal puncta and computed tomography findings of a swollen lacrimal sac indicated a diagnosis of lacrimal dacryostenosis. At this point, the pain and dizziness as a side effect of carbamazepine had become intolerable. Endoscopic intranasal dacryocystorhinostomy confirmed stenosis of the nasolachrymal duct and a thickened lacrimal sac. The postoperative course was uneventful, and the facial pain disappeared. This experience suggests the importance of recognizing lacrimal dacryostenosis as a differential diagnosis of facial pain around the eyes and nose. We also recommend a review of an original diagnosis of trigeminal neuralgia if carbamazepine fails to relieve facial pain.

Endoscopic treatment of nasolacrimal sac obstruction secondary to fibrous dysplasia of paranasal sinuses

Fibrous dysplasia involving paranasal sinuses mostly has asymptomatic features, but sometimes may cause signs and symptoms which relate to the location and extent of bony abnormalities. The use of endoscopic nasal surgery for debulking ethmoidal fibrous dysplasia, blocking the left nasolacrimal sac and simultaneous intranasal endoscopic dacryocystorhinostomy with silicone intubation is presented. The procedure and advantages of endoscopic approach over the external approach are outlined in this paper.

Clinical usefulness of endoscopic intranasal dacryocystorhinostomy

Conclusions. Endoscopic intranasal dacryocystorhinostomy (DCR) has the following advantages over external surgery: pain and hemorrhage are minimal; postoperative facial swelling and scarring are absent; and symptoms resolve rapidly after surgery. Furthermore, as no significant differences in postoperative results were apparent between external and endoscopic intranasal DCR, and because no facial skin incision is required, the clinical usefulness of endoscopic intranasal DCR is high. Objectives. In the treatment of nasolacrimal duct obstruction or chronic dacryocystitis in which epiphora or ocular discharge are chief complaints, endoscopic intranasal DCR is a safe, easy, minimally invasive, and reliable approach. In the present study, we describe the surgical procedures, techniques, and results of endoscopic intranasal DCR, and investigate its clinical usefulness. Subjects and methods. The subjects were 21 patients with nasolacrimal duct obstruction who underwent a total of 24 endoscopic intranasal DCR procedures. Etiologies of the obstruction were, respectively, cryptogenic (62.5%), secondary to partial maxillectomy (16.7%), complication of sinus surgery (12.5%), and due to underlying disease – Wegener's granulomatosis (4.2%) or nasal T-cell lymphoma (4.2%). To assess the clinical usefulness of this procedure, postoperative courses were assessed by reviewing medical records and conducting telephone interviews. In addition, to assess the therapeutic effects, postoperative results were statistically compared to those of external DCR. Results. Closure of the surgical opening was seen in two cases (8.3%). In both cases, after the closed region was opened using an endoscopic procedure, symptoms resolved. Finally, lacrimal passage obstruction was not observed by lacrimal irrigation in any patient. None of the patients in the present study experienced major complications during or after surgery, and since their symptoms improved, the degree of satisfaction was high. When compared to external DCR, endoscopic intranasal DCR showed no statistically significant difference in postoperative results, thus confirming that similar therapeutic effects could be obtained for the two procedures.

Endoscopic Assessment of the Dacryocystorhinostomy Ostium After Endoscopic Surgery

Dacryocystorhinostomy (DCR) is currently regarded as the treatment of choice for treatment of epiphora resulting from blockage at the level of the nasolacrimal duct. There has been debate on the effect of healing on the size of the DCR ostium after surgery. The aim of this study is to determine how the size of the surgically created lacrimal ostium changes over time. The authors conducted a prospective cohort study of unselected patients who underwent DCR from March 1999 to November 2004. Thirty-eight patients who underwent intranasal DCR were analyzed. There were 14 males and 24 females with 11 patients undergoing bilateral DCR, resulting in 49 endoscopic intranasal DCRs being analyzed. The endoscopic findings of the size of the ostia were recorded at the time of surgery and at 4 weeks, 6 months, and 12 months after surgery. There were 33 DCRs reviewed at 12 months and 16 reviewed at 6 months who did not reattend for their 12-month appointment. Analysis of variance was used to compare the difference in the ostium sizes at the end of surgery and at 4 weeks, 6 months, and 12 months after surgery. The male to female ratio was 1:1.7 and the average age was 64.5 (standard deviation [SD]=17.8 years). The ostium measured 11.8 (STD=2.3, 95% confidence interval [CI]=11.1-12.5)x7.2 (SD=1.7; 95% CI=6.7-7.7) at the time of surgery and 10.1 (SD=2.3; 95% CI=9.3-10.9)x6.4 (SD=1.3; 95% CI=6.0-6.9) at 4 weeks, 9.8 (SD=2.5; 95% CI=9.0-10.6)x6.5 (SD=1.5; 95% CI=6.0-6.9) at 6 months, and 10.1 (SD=2.5; 95% CI=9.2-11.0)x6.6 (SD=1.6; 95% CI=6.0-7.1) at 12 months. Statistical analysis (analysis of variance) showed a significant shrinkage from surgery to 4 weeks but no statistical difference from 4 weeks to 6 or 12 months. The DCR ostium shrinks a small but significant amount in the first 4 weeks after surgery. Thereafter, the ostium size appears to be stable. We propose that the surgical technique used in which the nasal and lacrimal mucosa is approximated results in a first intention healing with minimal ostial granulation tissue and stenosis and minimal shrinkage of the postoperative DCR ostium.

Long-Term Follow-up Outcomes of Nonlaser Intranasal Endoscopic Dacryocystorhinostomy: How Suitable and Useful are Conventional Surgical Instruments?

To investigate the long-term follow-up outcomes of nonlaser intranasal endoscopic dacryocystorhinostomy (IEDCR) using a nasal endoscope and conventional surgical instruments available in all operating rooms, the advantages of this technique, and the usability and suitability of conventional instruments. Twenty-seven IEDCRs were performed in combination with bicanalicular silicone intubation on 24 patients with primary nasolacrimal sac or duct obstruction who had undergone no previous procedures. Ablation of the nasal mucosa was performed with a sickle blade (12 operations) or insulated sickle blade allowing simultaneous intranasal monopolar cauterization (15 operations); a bony window was opened with a drill; and ablation of the medial wall of the lacrimal sac was performed with a sickle blade, Blakesley forceps, and Bellucci ear microscissors. Revision intranasal endoscopic surgery was performed in unsuccessful cases. Patients were followed up for 35 to 71 months (average 49.3 months). In 7 (25.9%) of the 27 IEDCRs, nasolacrimal obstruction recurred within 3 months. Success rates were as follows: 66.7% (8 operations) for the first 12 operations; 80% (12 operations) for the second 15 operations; and 74.1% overall. There were seven cases of surgical failure; revision surgery was successful in four, increasing the overall success rate to 88.9%. IEDCR can be performed with acceptable facility with standard conventional surgical instruments (sickle blade, endoscopic forceps, and scissors) and surgical tools (drill, monopolar cautery) found in all operating rooms, and the nonlaser intranasal endoscopic approach may be a reasonable alternative to the laser assisted surgery approach.

Long-term follow-up outcomes of nonlaser intranasal endoscopic dacryocystorhinostomy:How suitable and useful are conventional surgical instruments?

To investigate the long-term follow-up outcomes of nonlaser intranasal endoscopic dacryocystorhinostomy (IEDCR) using a nasal endoscope and conventional surgical instruments available in all operating rooms, the advantages of this technique, and the usability and suitability of conventional instruments. Twenty-seven IEDCRs were performed in combination with bicanalicular silicone intubation on 24 patients with primary nasolacrimal sac or duct obstruction who had undergone no previous procedures. Ablation of the nasal mucosa was performed with a sickle blade (12 operations) or insulated sickle blade allowing simultaneous intranasal monopolar cauterization (15 operations); a bony window was opened with a drill; and ablation of the medial wall of the lacrimal sac was performed with a sickle blade, Blakesley forceps, and Bellucci ear microscissors. Revision intranasal endoscopic surgery was performed in unsuccessful cases. Patients were followed up for 35 to 71 months (average 49.3 months). In 7 (25.9%) of the 27 IEDCRs, nasolacrimal obstruction recurred within 3 months. Success rates were as follows: 66.7% (8 operations) for the first 12 operations; 80% (12 operations) for the second 15 operations; and 74.1% overall. There were seven cases of surgical failure; revision surgery was successful in four, increasing the overall success rate to 88.9%. IEDCR can be performed with acceptable facility with standard conventional surgical instruments (sickle blade, endoscopic forceps, and scissors) and surgical tools (drill, monopolar cautery) found in all operating rooms, and the nonlaser intranasal endoscopic approach may be a reasonable alternative to the laser assisted surgery approach. (Eur J Ophthalmol 2004; 14: #-60).

Obstruction of the nasolacrimal duct: 3-year experience on intranasal endoscopic dacryocystorhinostomy with ultrasounds

Obstruction of the nasolacrimal duct: 3-year experience on intranasal endoscopic dacryocystorhinostomy with ultrasounds

Long-term Results and Reasons for Failure of Intranasal Endoscopic Dacryocystorhinostomy

The aim of this study was to evaluate the long-term results and the factors influencing the success in patients with nasolacrimal duct obstruction treated with intranasal endoscopic dacryocystorhinostomy (DCR) and silicone tube intubation (STI). We prospectively investigated 158 patients with lacrimal obstruction in two groups, one of which comprised 108 patients treated primarily with intranasal endoscopic DCR by experienced surgeons and the other comprised 50 patients who were operated on by inexperienced surgeons. In a mean follow-up time of 49 months the surgical success was 94.4% in experienced hands and 58.0% in inexperienced hands. The endoscopic examination of six patients with failure in the first group revealed granulation tissue around the tube in four, atonic sac in one and persistence of bone that was supposed to have been excised in the nasal cavity in one. There were 21 failures out of 50 patients in the second group: granulation tissue in 2 cases, fenestration to the nasolacrimal duct instead of the sac in 6 cases, synechia between the lateral nasal wall and the middle turbinate in 2 cases, bony spicles causing obstruction in 5 cases and fenestration anterior to the sac in 2 cases. In 4 cases no reasons were found for failure, but perhaps the small fenestration and failure to remove the medial half of the membranous sac wall was the reason. DCR and STI can be performed for primary treatment in lacrimal obstruction. There is a learning curve for the operation. False localization of the lacrimal sac, granulation tissue formation around the tubes, retained bony spicles, inadequate removal of the medial wall of the sac and the synechia between the lateral wall and the middle turbinate are the most common causes of failure.

Causes of failure in intranasal endoscopic dacryocystorhinostomy

Causes of failure in intranasal endoscopic dacryocystorhinostomy

Intranasal Endoscopic Surgery with Silicone Intubation for Lacrimal Obstruction

Endoscopic intranasal dacryocystorhinostomy (DCR) with silicone intubation has been evaluated as a primary treatment of lacrimal obstruction in 30 patients and for revision of conventional DCRs in 4 patients. Lacrimal obstruction was completely relieved in 28 (93.3%) of 30 primary procedure patients, and in three of four previously operated patients after a mean follow-up of 18 months. No intraoperative complications were observed. The average period of time of silicone tube intubation was 2 months. Intranasal endoscopic DCR with silicone intubation is an effective method in treatment of nasolacrimal duct obstructions and should also be considered in patients with recurrent epiphora after external DCR.

Functional endoscopic transnasal dacryocystorhinostomy.

Endoscopic nasal surgical techniques are revolutionising the management of nasal and sinus disorders. Historically the surgical approach to the nasolacrimal sac and duct has been indirect by an external approach because of poor visualisation intranasally. The nasolacrimal apparatus is, however, intimately related to the lateral nasal wall and may readily be approached using an endoscopic technique which minimises functional interference with the physiological action of the lacrimal pump. This paper describes a technique of endoscopic intranasal dacryocystorhinostomy which has success rates comparable to those obtained by the more conventional external approach.

The Prognostic Value of Preoperative Dacryocystography in Endoscopic Intranasal Dacryocystorhinostomy

Endoscopic intranasal dacryocystorhinostomy has been used as a primary treatment of lacrimal obstruction and for revision of conventional dacryocystorhinostomy. This study correlates dacryocystographic anatomy with the success of the endoscopic surgical technique. Eighteen patients with epiphora and nasolacrimal obstruction underwent operations. Preoperative dacryocystography identified 11 patients with either normal or enlarged lacrimal sacs, and seven patients with cicatrized lacrimal sacs. Patients with lacrimal sac stones and tumors were excluded. Endoscopic intranasal dacryocystorhinostomy was successful in nine of 11 (82%) patients with normal or enlarged lacrimal sacs, and in two of seven (29%) patients with cicatrized lacrimal sacs. The endoscopic technique was much more successful with normal or enlarged lacrimal sacs than with cicatrized lacrimal sacs (P = .049). Lacrimal sac anatomy as determined by preoperative dacryocystography is an important prognostic factor in technically achieving surgical success.

Endoscopic Intranasal Dacryocystorhinostomy Results in Four Patients

Dacryocystorhinostomy is commonly performed through an external incision. Several transnasal approaches were described earlier in this century but they failed to gain popularity probably because of the difficult exposure. The recent development of nasal endoscopes has greatly improved intranasal visualization. A prior cadaver study demonstrated the feasibility of a transnasal approach. This study presents early results on four patients.