Ostial Patency Research Articles

Anatomical requirements for dacryocystorhinostomy ostium patency.

To identify anatomical factors affecting the outcome of dcryocystorhinostomy (DCR). The study included the results of dacryocystography in 73 patients after DCR: 37 cases of failed DCR and 36 cases of successful DCR. Biometric characteristics of the formed ostium were evaluated: the horizontal size of the bony "window" and the soft tissue part of the ostium, the vertical size of the bony "window" and soft tissue ostium, the height of the fragment of the remaining bone above and below the line of the common canaliculus, and the height of the "pocket" formed below the lower edge of the ostium. Statistical analysis was performed using parametric and non-parametric statistical methods. Differences were considered significant at p ≤ 0.05. Intergroup differences were identified in the values of the maximum horizontal size of the bony "window" (p = 0.015), the maximum horizontal size of the soft tissue "window" (p < 0.001), the maximum vertical size of the soft tissue "window" (p < 0.001), and the height of the fragment of the remaining bone below the level of the common canaliculus to the edge of the formed ostium (p = 0.004). The stage of forming the bony "window" influences the success of DCR. Not only the position of the "window" is important, but also the geometric properties of the formed ostium.

Peri-implantitis and maxillary sinus membrane thickening: A retrospective cohort study.

The objective of this study is to investigate the association of peri-implantitis (PI) and sinus membrane thickening and to assess the resolution of membrane thickening following intervention (implant removal or peri-implantitis treatment) aimed at arresting PI. Forty-five patients with 61 implants in the posterior maxillary region were retrospectively included in the study. Twenty-four patients were diagnosed with peri-implantitis (PI) and 21 had peri-implant health (PH). Cone-beam computed tomography (CBCT) scans were evaluated to assess maxillary sinus characteristics, including membrane thickening, sinus occupancy and ostium patency. The CBCT scans taken 6 months after intervention aimed at arresting disease (implant removal or treatment of PI) in the PI group were also appraised and compared to baseline scans. At baseline, all parameters evaluating membrane thickness disorders yielded significant differences between groups (p < .001). Patients with posterior maxillary implants diagnosed with PI were 7× more likely to present membrane thickening compatible with pathology when compared to patients with healthy implants (OR = 7.14; p = .005). Furthermore, the likelihood was 6x greater in implants diagnosed with PI to exhibit moderate membrane thickening (OR = 6.75, p = .001). The patients receiving interventions aimed at arresting PI experienced significant enhancement in all radiographic parameters related to the sinus cavity at the 6-month follow-up (p < .001), though these variations were similarly independent of whether treatment consisted of PI treatment or implant removal. Maxillary sinus membrane thickening and the permeability/obstruction of the ostium are frequently associated with the presence of PI in posterior implants. Interventions targeting disease resolution effectively reduce membrane thickness to levels compatible with maxillary sinus health.

Enhancing Frontal Sinus Surgery: Assessing the Long-Term Impact of Free Grafts and Flaps in Draf III Procedures.

The frontal sinus medial drainage -Draf Type III (modified endoscopic Lothrop) procedure, has become a cornerstone in frontal sinus surgery over the last three decades. Despite its widespread acceptance, challenges such as restenosis and neo-ostium closure persist, prompting the exploration of various preventive techniques. In this retrospective study, we analyzed data from 111 patients who underwent the Draf III procedure between November 2015 and November 2023, with a mean follow-up period of 3 years and 11 months. Approximately two-thirds of patients (64%) had undergone previous sinus surgery and 16% a previous Draf III. Over half of the patients had inflammatory conditions, with the majority being chronic rhinosinusitis with nasal polyps (CRSwNP) (46%), while 15% were diagnosed with malignant sinonasal tumors, and 23% with benign sinonasal tumors, of which the commonest was osteoma, accounting for 14 cases. The mean follow-up period was 3 years and 11 months. We focused on evaluating the efficacy of mucosal flaps and free grafts in preventing neo-ostium closure. Although it appears that there is no statistically significant correlation between flap usage and the need for revision surgery or ostium patency maintenance overall, subgroup analysis highlighted the benefits of flap reconstruction in patients with chronic rhinosinusitis with nasal polyps. In this subgroup, the use of flaps or grafts reduced the rate of neo-ostium stenosis from 20% to 0% (p < 0.05). Overall revision rate was 11.7%-however this was 8% in patients without acute inflammation at the time of surgery and went up to 31% in the presence of pus in the frontal recess (p = 0.02). This study contributes to the existing literature by providing insights into long-term outcomes, the enduring effectiveness of interventions in frontal sinus surgery, and especially the importance of taking into account the underlying pathology when assessing long-term outcomes.

Chitogel with deferiprone following endoscopic sinus surgery: improved wound healing and microbiome.

Adhesion formation, sinus ostial narrowing, and presence of pathogenic bacteria are associated with poor outcomes following endoscopic sinus surgery (ESS) for chronic rhinosinusitis. Chitogel has been shown to improve wound healing, restore a healthier microbiome, and reduce post-operative infections post ESS. Deferiprone has antibacterial properties and has been shown to reduce adhesion formation. The aim of the study was to assess whether the addition of low concentration deferiprone to Chitogel further improves surgical outcomes following ESS compared with Chitogel alone. In this double-blinded trial, 45 patients undergoing ESS were prospectively recruited. At the end of the surgery, patients were randomised to receive Chitogel alone, Chitogel with 1 mM of deferiprone, or Chitogel with 5 mM of deferiprone to one side of the sinuses (allowing the other side to serve as control). Patients underwent routine follow-ups with symptom questionnaires and nasoendoscopies performed at 2, 6, and 12 weeks post-operatively. Sinus ostial measurements, microbiology, and microbiome swabs from bilateral middle meatuses were collected intraoperatively and at 12 weeks post-operatively. A significant improvement in the endoscopic appearance of the sinuses and frontal ostial patency was noted at 12 weeks post-operatively (p < 0.05) in all three treatment groups compared with the control. There was no significant difference noted between patients who received Chitogel alone and those who received Chitogel with 1 or 5 mM deferiprone. Chitogel alone, Chitogel with 1 mM deferiprone, and Chitogel with 5 mM deferiprone used following ESS led to a significant improvement in endoscopic appearance of the sinuses and frontal ostial preservation at 12 weeks post-operatively. No significant difference was found with the addition of deferiprone to Chitogel.

Long-term outcomes of modified transcanalicular diode laser dacryocystorhinostomy.

The purpose of this study is to assess the long-term outcomes of modified transcanalicular diode laser dacryocystorhinostomy in a large cohort of patients affected by primary acquired nasolacrimal duct obstruction. This study, conducted from January 17 to June 2022, encompassed 141 patients (159 procedures) who underwent modified transcanalicular diode laser dacryocystorhinostomy (MT-DCR). The procedure employed an 810-nm diode laser. Patients were monitored for at least a year after the intervention. Anatomical success was determined by ostium patency upon irrigation, while functional success referred to epiphora resolution. Parameters studied included patient demographics, procedure duration, complications, and both anatomical and functional success. Statistical analysis was performed using the Statistical Package for the Social Sciences software, with results considered significant at a 95% confidence interval (p≤0.05). A total of 159 lacrimal drainage systems (141 patients: 112 women and 29 men) were included in this study. Among them, 18 underwent bilateral procedures. The average patient age was 58 years (range: 34-91 years), and the average surgical duration was 24 minutes (range: 18-35 minutes). One year after the surgery, MT-DCR exhibited anatomical and functional success rates of 84.9% (135/159) and 83% (132/159), respectively. MT-DCR achieved an anatomical success rate of 84.9%, reflecting an excellent outcome. However, further extensive studies with larger sample sizes and longer follow-up periods are necessary to substantiate these findings.

Analysis of frontal sinus ostium variants based on computed tomography data

Introduction. The structure of the nasal cavity and the sinonasal region is crucial in selecting treatment methods for their pathologies. Endoscopic surgery of the frontal sinus requires an assessment of the position and diameter of the frontal ostium, which can be determined and classified by analyzing a series of sinonasal computed tomography scans. The aim of our study was to investigate possible variations in the position and dimensions of the frontal sinus ostium and determine their frequency in individuals of mature age using computered tomography data.Material and methods. The study was conducted by analyzing 40 series of anonymized archived computer scans of 20 men and 20 women of mature age. The material for the study was obtained at the "Lithotripsy Center" (Lviv) on the Siemens SOMATOM GO.UP 32 (64) device (Germany). The evaluation and determination of the frontal ostium diameter were performed using the method described by Gheriani H. et al.[5].Results. Three variants of frontal sinus ostia were identified: with a positive, neutral, and negative evaluation. In 70% of examined women and 60% of examined men, the frontal sinus ostia received a positive evaluation on both sides, while in 10% of women and 10% of men, it was only on one side. Frontal sinus ostia with a negative evaluation were observed in 20% of women and 10% of men on one side. In 30% of women and 20% of men, the frontal sinus ostia had a neutral evaluation on one side, and in 20% of men, it was on both sides. The diameter of frontal ostia in both groups of men and women showed significant variability. In the studied group of individuals of mature age, the most common category of frontal ostium passability was the second category (50%), and the rarest was the fourth category (10%). The frequency of visualization of frontal ostia of the first and third categories was 45% and 30%, respectively. The symmetry of categories passability of frontal ostia in men was 80%, which was twice as high as in women. In men, the first category of frontal ostium patency was most frequently observed (50% of examined men), while in women, it was the second category (80% of examined women). The fourth category of frontal ostium passability was the least common in both men and women, each accounting for 10% of individuals of both genders.Conclusion. Computed tomography allows to determine the position and size of the frontal sinus ostium, which is crucial for assessing the complexity of surgical intervention.

A Comparative Study of Endoscopic Endonasal Dacryocystorhinostomy with and without Stenting

Introduction: The definitive management of complete nasolacrimal duct obstruction from chronic dacryocystitis is surgical. The surgery of choice is dacryocystorhinostomy (DCR), which can be done external or endonasal with or without stenting. We aim to compare the anatomical and functional outcomes of endoscopic endonasal DCR with and without stenting. Materials and Methods: This prospective study was carried out involving 30 patients of either sex randomly divided into two groups of 15 patients each. Group A underwent endoscopic DCR with stenting of the canaliculi, whereas Group B underwent endoscopic DCR without stenting. These patients were followed up at week 1, 6, and 12. The success of surgery in each group was determined by the absence of epiphora (Munk scale grades: 0 and 1), patent ostium on irrigation, positive Jones test, and decrease in the marginal tear film volume as seen on dye disappearance test (grade: 0 and 1) at week 12. Final data were analyzed using SPSS 21 version. Results: About 86.6% success rate was noted in the group where stenting was done (Group A) compared to 100% success in the group without stenting (Group B). This difference was, however, not statistically significant (P = 0.143). Failures in the study were attributed to the closure of rhinostomy ostium at week 12 follow-up. The most common complication noted was postoperative pain around the bridge of nose. Stent-related complications such as conjunctivitis and difficulty in removal of the stent were also noted. Conclusion: In our study, the surgical results of endoscopic endonasal DCR without stenting were better than endoscopic dacryocystorhinostomy with stenting both anatomically as well as functionally.

Outcomes of 8 × 8 mm osteotomy in powered external dacryocystorhinostomy.

To study the endoscopic ostium characteristics and outcome of 8 × 8 mm osteotomy in external dacryocystorhinostomy (DCR) using the microdrill system. This prospective interventional pilot study was performed on 40 eyes of 40 patients with primary acquired nasolacrimal duct obstruction (NLDO) from June 2021 to September 2021 in patients undergoing external DCR. An 8 × 8 mm osteotomy was performed using round, cutting burr attached to a microdrill system. Success was defined as patent ostium on lacrimal syringing (anatomical) and a Munk score <3 (functional) at 12 months. Postoperative endoscopic ostium evaluation was done using a modified DCR ostium (DOS) scoring system at 12 months. The mean age of the study participants was 42.41 ± 11.77 years and the male-to-female ratio was 1:4. The mean duration of surgery was 34.15 ± 1.66 minutes and that for osteotomy creation was 2.5 ± 0.69 minutes. The mean intraoperative blood loss was 83.37 ± 11.89 ml. Anatomical and functional success rates were 95% and 85%, respectively. The mean modified DOS score was "excellent" in 34 patients (85%), "good" in 1 patient (2.5%), "fair" in 4 patients (10%), and "poor" in 1 patient (2.5%). Complications included nasal mucosal injury in 10% (4/40) of patients, complete cicatricial closure of ostium in 2.5% (1/40), incomplete cicatricial closure in 10% (4/40), nasal synechiae in 5% (2/40), and canalicular stenosis in 2.5% (1/40). An 8 × 8 mm-sized osteotomy created by powered drill and covered by lacrimal sac-nasal mucosal flap anastomosis in external DCR is an effective technique that has minimal complications and shorter surgical time.

Radiopathologic predictors of 1- and 2-year frontal sinusotomy outcomes in a southeast Asian chronic rhinosinusitis population.

The frontal sinus and its drainage pathway are difficult spaces to navigate surgically. The complexity of the frontal recess anatomy as well as inflammatory factors may influence outcomes of endoscopic frontal sinusotomy. It is not clear which factors are more important in determining post-operative frontal ostium patency. The objective is to investigate whether the distribution of fronto-ethmoidal cells, frontal recess dimensions and sinonasal inflammation predict frontal ostium patency at 1- and 2-years after endoscopic frontal sinusotomy. A retrospective review of 94 chronic rhinosinusitis patients (185 sides) who had undergone endoscopic frontal sinusotomies between 2015 and 2019 was conducted. Computed tomography was used to evaluate the type of fronto-ethmoidal cells present and determine the dimensions of the frontal recess. The International Classification of the Radiological Complexity of frontal recess and frontal sinus was used to grade the complexity of frontal recess anatomy. Mucosal inflammation was graded according to a structured histopathology report. Frontal ostium patency at 1- and 2-years post-operatively was recorded. The frontal ostium patency rates were 80.9% and 73.4% at 1- and 2-years respectively. Eosinophilic predominance (adjusted OR 3.5, 95% CI 1.6-8.0, p = 0.003) and mucosal ulceration on histology (adjusted OR 4.5, 95% CI 1.1-17.9, p = 0.033) predicted ostial stenosis at 1year. Smoking (adjusted OR 7.6, 95% CI 2.4-24.7, p = 0.001), aspirin exacerbated respiratory disease (AERD) (adjusted OR 7.6, 95% CI 1.9-30.1, p = 0.004) and histological findings of severe inflammation (adjusted OR 8.9, 95% CI 1.9-41.2, p = 0.005) were independent predictors of ostial stenosis at 2years. Frontal cell patterns, frontal recess dimensions and frontal recess complexity did not predict frontal ostium stenosis at both 1- and 2-years post-operatively. Post-operative control of sinonasal inflammation is important in maintaining frontal ostium patency, regardless of frontal cell patterns or frontal recess dimensions.

Ostial Patency Measurements After Endoscopic Sphenoidotomies and Frontal Sinusotomies.

Sphenoid and frontal sinuses have narrow ostia and are prone to stenosis. However, their relative rates of patency are not well established, and descriptive rates of sphenoid stenosis have never been reported. The objective is to measure the patency of the sphenoid and frontal sinus ostia postoperatively. A prospective multi-institutional cohort study was performed. Ostial patency was measured at surgery and 3 and 6 months postoperatively. Pertinent clinical history such as the presence of nasal polyps and prior history of ESS as well as the use of steroid eluting stents were recorded. Overall stenosis rates were calculated for both the sphenoid and frontal sinuses, and Wilcoxon-Signed Rank Test was used to compare intraoperative and postoperative ostial areas. Factorial Analysis of Variance (ANOVA) was performed to determine effects of 5 clinical factors. Fifty patients were included. The mean sphenoid sinus ostial area decreased 42.2% in size from baseline to 3 months postoperatively (T0 55.2 ± 28.7 mm vs T3 m 31.8 ± 25.5 mm, P < .001). The mean frontal sinus ostial area decreased 39.8% in size from baseline to 3 months postoperatively (T0 33.7 ± 17.2 mm vs T3 m 19.9 ± 15.1 mm, P < .001). Neither the sphenoid nor the frontal sinus ostial patency demonstrated statistically significant change from 3 to 6 months postoperatively. Both sphenoid and frontal sinus ostia routinely narrow postoperatively, predominately from baseline to 3 months. These findings can serve as a reference for both clinical outcomes and future studies of these surgeries.

No title.

It is of interest to compare the treatment modalities of sinus membrane thickening, by analyzing the difference in pre and post-intervention radiographic measurement of sinus membrane thickness. Results showed that combination therapy of steam and mucolytics decreased the sinus thickening in a statistically significant manner compared to mucolytics alone. Thus, there is a correlation between maxillary sinus membrane thickening and patency of maxillary ostium radiographically.

Effects of different grafting materials on volumetric changes in the Schneiderian membrane following lateral maxillary sinus floor elevation: a preliminary study

ObjectivesTo investigate the potential influence of different grafting materials on maxillary sinus membrane dimensions and ostium patency following lateral sinus floor elevation (SFE) as assessed using cone-beam computed tomography (CBCT).Materials and methodsA total of 40 sinuses in 40 patients were included. Twenty sinuses were referred for SFE with deproteinized bovine bone mineral (DBBM), and the remaining 20 sinuses were grafted with calcium phosphate (CP). CBCT was performed prior to and 3 to 4 days after surgery. The dimensions of the Schneiderian membrane volume and ostium patency were evaluated, and potential relationships between volumetric changes and any associated factors were analyzed.ResultsThe median increase in membrane-whole cavity volume ratios was 43.97% in the DBBM group and 67.58% in the CP group, demonstrating no statistically significant difference (p = 0.17). The rates of increased obstruction after SFE were 11.1% for the DBBM group versus 44.4% for the CP group (p = 0.03). The graft volume was found to be positively correlated with the postoperative membrane-whole cavity volume ratio (r = 0.79; p < 0.01) and the membrane-whole cavity volume ratio increase (r = 0.71; p < 0.01).ConclusionsThe two grafting materials seem to have a similar effect on transient volumetric changes in the sinus mucosa. However, the choice of grafting material should still be made with caution since sinuses grafted using DBBM exhibited less swelling and less ostium obstruction.

A Comparative Study of Surgical Outcome in Endoscopic Endonasal Dacrocystorhinostomy with and without Stenting

Introduction To remove tears from people’s eyes’ – is one of the greatest challenges of lacrimal surgery. Epiphora is defined as watering eye due to inadequate drainage of normally produced tears. Dacryocystitis is the inflammation of the lacrimal drainage system which presents as acute dacryocystitis or a much commonly as chronic dacryocystitis. Other common causes of ephiphora are blepharitis, conjunctivitis, trichiasis, punctal eversion and foreign bodies. The conventional treatment for watering eyes due to Naso Lacrimal Duct (NLD) is the procedure of external dacryocystorhinostomy (DCR) which has its own limitations and disadvantages. With the introduction of high resolution endoscopes for paranasal sinuses, endoscopic endonasal DCR (EnDCR) is gaining popularity. The main advantages of the endoscopic technique are minimal morbidity, less intraoperative bleed, shorter operative time, preservation of pump function of orbicularis occuli muscle, presaccal fibers and medial canthal tendon and avoidance of cutaneous scar. In EnDCR the most common cause for failure of surgery is closure of rhinostoma and to prevent this silicone tube insertion is the most preferred method. It has also been claimed that silicone tubing would improve surgical results. But studies also indicate that silicone tubing itself results in certain problems like, foreign body sensation, increased granulation tissue leading to failure, prolapse of tube leading to injury to cornea, nasal migration of tube, fistula formation, pharyngitis and associated sinusitis &amp; recurrent nose bleed. The present study was undertaken to compare the surgical results of endoscopic endonasal DCR with and without silicone stent. Aims &amp; Objectives To compare the success rates of endonasal dacryocystorhinostomy and evaluate the presence of post-operative changes and their effect on the outcome of the surgery in endoscopic dacryocystorhinostomy with and without stenting. Material &amp; Methods This Prospective randomized comparative study was carried out amongst the patients attending department of ENT and referred cases from ophthalmology department for chronic nasolacrimal duct obstruction, both as inpatients and outpatients with complaint of chronic epiphora. 50 patients divided into two groups of 25 each fulfilling inclusion and exclusion criteria were included using convenient sampling. Participants were divided into two groups of 25 each based on randomization technique. Group 1 includes patients undergoing EnDCR with stenting and Group 2 includes patients undergoing EnDCR without stenting. Patients were assessed for post-operative complications like granulations, size of the neo ostium and patency of the neo ostium were assessed on nasal endoscopy. Data was entered in MS Excel work sheet. Data was analyzed using appropriate statistical methods. Result This study had Female predominance in both the groups. No predominance for any side was observed. No major intra operative complications were observed. Duration of surgery was more in Group I which was statistically significant. Post-operative complications are seen more in group without stenting (64.0%) than in group with stenting (56%) with no statistical difference between the two groups. Granulations had no effect on the outcome of the. On subjective assessment of symptoms 92% of patients in group I and 88% of patients in group II showed improvement of symptoms post operatively. No statistical difference had been found between the results of both the groups. On objective assessment of size of the neo ostium, no statistical difference was seen between the two groups. The size of the neo ostium had no effect on the outcome of the surgery. On objective assessment of patency of the neo ostium was observed in 92% of patients in group I and 88% patients in group II with no statistical difference between the two groups. Conclusion As success rates of the surgery with stenting and without stenting are comparable and

Changes in sinus mucosal thickening in the course of tooth extraction and lateral sinus augmentation with surgical drainage: A cone-beam computed tomographic study.

The objective of the study was to evaluate the radiographic changes in sinus mucosal thickness (SMT) in patients with mucosal thickening of odontogenic origin after maxillary molar extraction and lateral sinus augmentation with simultaneous surgical drainage and implant placement. Forty-six patients were included in this study. The changes in SMT were evaluated using cone-beam computed tomography images produced at four time points: before extraction (T0), before surgery (T1), immediately after surgery (T2), and after prosthesis delivery (T3), and statistical differences between time points were analyzed. The changes in SMT and augmented bone height (ABH) regarding the reason of extraction, smoking, ostial patency, and the presence of postoperative sinusitis were also evaluated. Over time points, SMT gradually decreased (T0: 19.44 ± 9.22 mm, T1: 15.10 ± 8.89 mm, T2: 8.42 ± 6.01 mm, and T3: 4.16 ± 4.91 mm) (p < .05). Five out of 6 patients with ostial obstruction at T1 presented ostial patency at T3. Two patients developed postoperative sinusitis but recovered with medication. Ostial patency at T1, SMT at T1, and reason of extraction did not statistically significantly influence SMT at T3. SMT at T1 had no statistically significant impact on ABH change between T2 and T3. Sinus mucosal thickness was gradually reduced by extraction of compromised teeth and drainage during lateral sinus augmentation. The drainage contributed more to the reduction in SMT.

Emergent In Situ Fenestration in the Ascending Aorta for the Endovascular Repair of a Large Pseudoaneurysm: A Technical Note

Purpose: The purpose of this article is to describe an emergent in situ fenestration (ISF) technique in the ascending aorta for the endovascular repair of a large pseudoaneurysm using a trans-septal needle device through direct right common carotid artery access, in a patient with left ventricular assist device (LVAD). Technique: We performed, in a multidisciplinary team-work approach, an emergent ISF to correct the displacement of a physician-modified thoracic endograft released in the ascending aorta to correct a large anastomotic pseudoaneurysm in a patient who underwent ascending aorta replacement and subsequent LVAD implantation. We used a trans-septal needle device inserted through a direct access to the right carotid artery and performed an ISF to restore the patency of the outflow ostium of the LVAD. Window was then completed and stabilized with a nitinol balloon expandable covered stent graft obtaining an effective exclusion of the anastomotic aortic aneurism and the regular patency of the LVAD outflow graft with no signs of leaks. Conclusions: Multidisciplinary teamwork approach can be crucial in challenging procedures where an alternative approach may lead to problem solving. The ISF technique may be a valid option to adopt in emergency cases in which no other technical solutions are suitable. Clinical Impact The endovascular approach has become more and more frequent for the treatment of vascular pathologies, getting increasingly refined and complex. Thereby the chance of incurring intraprocedural troubles has grown and bailout strategies should always be present. In situ fenestration is a technique to be aware of and that could help you recover from difficult situations. We report a possible rescue maneuver that can be applied also in arduous anatomies such as the ascending aorta. Moreover, we would like to highlight the importance of a multidisciplinary working environment that can enrich our everyday practice accomplishing effective and unexpected solutions.

A simple and efficient technique for suturing and knotting during endoscopic dacryocystorhinostomy

PurposeThis study evaluated the long-term outcomes of endoscopic suturing and knotting-dacryocystorhinostomy (eSK-DCR) without the use of a stent or mitomycin C.MethodsA prospective interventional case series was performed on patients with nasolacrimal duct obstruction (NLDO) who underwent eSK-DCR at Zhongshan Ophthalmic Center from October 2019 to December 2019. The surgeon sutured the lacrimal sac mucosa with the nasal mucosa by tying knots under endoscopic DCR. Subject demographics, preoperative data and postoperative data were collected, including clinical presentation, Munk score for epiphora, surgical indications, operation time, duration of knotting, number of knots, endoscopic ostium size, complications, and anatomical and functional success. Anatomic success was defined as patent ostium on lacrimal irrigation, and functional success was defined as subjective improvement in symptoms. Statistical analysis was performed by IBM SPSS software (Version 20.0; SPSS Inc., Chicago, IL, USA).ResultsA total of 60 patients (71 eyes) underwent pure eSK-DCR. Of these, 95.0% (57/60) were females. The mean age of the patients was 54.7 years. The mean surgical time was 37.60 min, and the average time for each knotting was 2.86 min. Endoscopic evidence found that all patients showed patent ostium and normal healing of the flaps after 4 weeks. The Munk scores dropped significantly at 6 months postoperatively compared to preoperative scores (P < 0.0001). Although 4 patients (7 eyes) were lost to follow-up at the end of the 2-year period, the anatomical and functional success remained stable during the 2-year follow-up period (anatomical, 100%; functional, 87.5%). No serious complications were detected during the follow-up period.ConclusionPure eSK-DCR is a simple and reliable therapeutic method for the management of NLDO. The surgical outcomes were good and remained stable beyond 6 months postoperatively.

Relationship of Maxillary Sinus Mucosal Thickening and Residual Alveolar Ridge Height: A CBCT Analysis

Objectives: Maxillary sinus pathological conditions, like thickening of the Schneiderian membrane, can influence the outcomes of augmentation procedures and implant treatment. The present study aimed to evaluate the relationship between the residual ridge height and maxillary sinus membrane thickening. Materials and Methods: A total of 240 cone-beam computed tomography (CBCT) images of the maxillary sinus of 141 patients (62.1% males and 37.9% females, bilateral in 99 patients and unilateral in 42 patients) who were candidates for implant placement were evaluated. The CBCT scans were subsequently assessed for the following variables: residual ridge height, sinus membrane thickening at future implant(s) site(s), the ostium patency, and presence of periapical lesion adjacent to the edentulous area. Results: The total prevalence of sinus membrane thickening (66.2%) was sub-classified as follows: flat in 53.7%, polypoid in 12.1%, and complete opacification in 0.4%. The prevalence of sinus membrane thickening was higher in male participants. It was revealed that age had no significant relationship with presence of a periapical lesion or sinus membrane thickening (P>0.05). Membrane thickening was detected in all sinuses with obstructed ostium. Reduced residual ridge height was significantly associated with higher sinus membrane thickening at the second premolar and first molar sites (P<0.05). Conclusion: Maxillary sinus membrane thickening (mostly with flat appearance) is frequently observed on CBCT scans taken prior to augmentation and implant placement. This, in return, may trigger a reduction in ridge height.

Flap suturing endonasal dacryocystorhinostomy assisted by ultrasonic bone aspirator

Background In the external dacryocystorhinostomy (DCR), a sutured anastomosis technique performed between the nasal mucosal and lacrimal sac flaps reported by Dupuy-Dutemps and Bourguet was the gold standard and was believed to lead to the success of the surgery. However, because of the small working space, a flap suturing technique has not been completely established in endonasal DCR (END-DCR). Objectives The effect of the modified flap suture anastomosis technique using a Sonopet ultrasonic bone aspirator was retrospectively compared to that using a diamond burr in patients with nasolacrimal duct obstruction. Materials and Methods One hundred ten patients underwent the modified flap suturing technique using the Sonopet, and 30 patients were operated on using a diamond burr. Results Successful patency of the lacrimal ostium (LO) was obtained in all patients in both groups. The rates of successful suturing during the operation and of a large diameter of the LO 3 months after the operation were significantly higher in patients in whom the Sonopet rather than the burr was used. Conclusions and Significance The Sonopet might offer similar surgical outcome to the traditional microdrill DCR and is a safer means of bone removal in END-DCR in the small working space.

Endoscopic dacryocystorhinostomy for refractory nasolacrimal duct obstruction with asmall lacrimal sac (≤ 5mm in diameter).

Although endoscopic dacryocystorhinostomy (DCR) is a standard procedure for nasolacrimal duct obstruction (NLDO), the failure rate remains approximately 10%. A small lacrimal sac is considered the main reason for surgical failure. We explored the efficacy of endoscopic DCR for the treatment of NLDO with a small lacrimal sac. The clinical data of 72 patients (88 eyes) diagnosed with NLDO and undergoing endoscopic DCR from 2012 to 2020, with at least 24months of follow-up were retrospectively collected. Intraoperatively, the Rosenmüller valves were fully exposed, mucosal flaps were preserved to cover the naked bone, and a silicone tube was implanted if necessary. Postoperative intervention was performed if necessary. The main outcome measures were symptomatic improvement and objective ostium patency. Eighty-eight eyes of 72 patients were divided into two groups: the refractory group (34 patients, 47 eyes), with a small lacrimal sac (≤ 5mm in diameter), and the simple group (38 patients, 41 eyes). Patients with small lacrimal sacs were more prone to bilateral eye disease than those in the simple group (P = 0.014) and required a longer postoperative follow-up (P < 0.001). Refractory NLDO and simple NLDO had a success rate of 91.5% and 95.1%, respectively, with no significant difference. Endoscopic DCR for refractory NLDO with a small lacrimal sac could achieve a beneficial result by exposing the Rosenmüller valves, preserving mucosal flaps, implanting necessary intubation, and intervening postoperatively. Thus, a small lacrimal sac should not be regarded as a contraindication to surgery.

Evaluation of Related Factors of Maxillary Sinusitis After Le Fort I Osteotomy Based on Computed Tomography: A Retrospective Case-Control Study.

Maxillary sinusitis is 1 of the postoperative complications of the Le Fort I osteotomy, this study investigated the related factors of maxillary sinusitis after Le Fort I osteotomy. A total of 23 cases, 92 controls, and 11 related factors were included in this case-control study with a 1:4 case-control ratio. The risk factors for maxillary sinusitis after Le Fort I were examined by least absolute shrinkage and selection operator multivariate conditional logistic regression and least absolute shrinkage and selection operator multivariate linear regression. The patency of maxillary sinus ostium at 6 months after surgery was significantly associated with maxillary sinusitis after Le Fort I osteotomy. Compared with the obstructed maxillary sinus ostium, the percentage of the volume of the healthy air cavity in the complete sinus cavity increased 70.7% when the maxillary sinus ostium was unobstructed, and 95% confidence interval was 0.610 to 0.805. Similarly, when the maxillary sinus ostium was wide, the percentage increased 6.0% compared with the narrow 1, and 95% confidence interval was 0.013 to 0.107. This study indicated that the patency of maxillary sinus ostium has an important impact on maxillary sinusitis after Le Fort I osteotomy. Close attention should be paid to maintain the maxillary sinus ostium and the drainage of maxillary sinuses unobstructed in a clinical setting.