Silastic Sheet Research Articles

Use of Butterfly Composite Conchal Cartilage Graft with Local Posteriorly Pedicled Flap in Repair of Nasal Septum Perforations

Background : Nasal septal surgery is the most frequent cause of nasal septal perforations (NSP). Sometimes when symptomatic they need repair. There are many methods described for repair with a variable percent of success. The multiplicity of techniques and approaches reflect the difficulty of repair.Objective: To describe a new effective method to repair NSP using a butterfly composite conchal cartilage graft (BCG) with local posteriorly pedicled flap in repair of NSP.Patients and Methods: Eleven patients with NSP after nasal septum surgery were involved in this study. In all of them an ample flap, right sided, pedicled posteriorly on sphenopalatine artery was fashioned. It was rotated to cover the perforation on the right side. A composite skin choncal cartilage graft equal to NSP diameter is dissected. The cartilage graft was fashioned by splitting its edge circumferentially with a depth of 2-3 mm and was positioned with the skin island lying on the left side and the fissured graft edge embracing the perforation cartilaginous border inside its fissure. The graft and the flap were fixed in place with quilting and mattress sutures and silastic sheets on both sides. Mucosal flap was used alone in three cases with small perforations.Results: Complete closure of NSP was achieved in 10 cases (91%). Only one case the graft was rejected with partial closure of the perforation due to bad fixation and secondary infection.Conclusion: BCG was an excellent graft to repair NSP if associated with posteriorly pedicled mucosal flap supplied by the sphenopalatine artery.

Use of Thermoplastic Splint for the Treatment of Auricular Hematoma.

Auricular hematoma is commonly seen in ear nose and throat clinical practice and mostly caused by blunt trauma as a result of traffic accident, wrestling, boxing etc. If hematoma does not discharge, blood supply of the cartilage fails and this results with the necrosis of the auricular cartilage. Incision and drainage of the hematoma is the cornerstone of the surgical treatment and simple compression methods are limited in terms of their ability to eliminate the empty space. Various techniques have been described for the elimination of the death space such as; dental rolls, cotton bolsters, buttons, silastic sheets, etc but compression materials may be insufficient to apply this pressure because of irregular shape of auricle. Resolving these problems, the authors have used thermoplastic splint as a compressive material at 7 patients for elimination of the death space in auricular hematoma treatment.

Combined Free Inferior Turbinate Mucosal Grafting with Silastic Sheet Stenting for the Prevention of Restenosis in Extended Frontal Sinus Surgery

Combined Free Inferior Turbinate Mucosal Grafting with Silastic Sheet Stenting for the Prevention of Restenosis in Extended Frontal Sinus Surgery

Determinants influencing success rates of myringoplasty in daily practice: a retrospective analysis.

The aim of this study was to determine influencing factors on tympanic membrane closure and their consequence on absolute risks of closure and hearing improvement in myringoplasties. Retrospective cohort. Medium-sized medical centrum. 195 patients were analysed who underwent a myringoplasty between January 2015 and February 2017 at the Jeroen Bosch Hospital in The Netherlands. Patient-related data, descriptions of the tympanic defect, surgical data, and the most important follow-up data were collected. Primary outcome is successful closure of the tympanic membrane and the secondary outcome is the amount of air-bone gap improvement after surgery. The overall success rate of the myringoplasty graft was 74.9%. If cartilage and butterfly graft were used, higher success rates of 85.4% and 85.5% were achieved compared to temporalis fascia (61.3%). Success rate of the operation was dependent of the skills of the surgeon. Chances of success are 91.9% if the operation is performed by an experienced surgeon using cartilage and 66.7% if a less experienced surgeon uses fascia. If a postoperative complication occurs or when silastic sheets are used, this might have a negative effect on the success of the operation. The mean ABG improved 10.10dB if the perforation was closed compared to 3.38dB after an unsuccessful procedure. The success rate of a myringoplasty is dependent of the skills of the surgeon and type of graft used and varies between 91.9 and 52.0% depending on these factors.

S1-20 SEPARATION OF CRANIOPAGUS TWINS – PHILOSOPHY, TECHNIQUES AND INNOVATION; LESSONS LEARNT FROM THE GOSH EXPERIENCE OF 3 SETS OF TWINS

Introduction: Craniopagus twins are rare entities with approximately 10 pairs surviving beyond the neonatal period per annum, globally. The outcome in most cases remains undocumented. The GOSH team has till date separated 3 sets of twins. We present here our cumulative experience of the 3 sets with a particular emphasis on the ‘lessons learned’ in the planning and execution of the separation. Methods: Three sets of craniopagus twins underwent separation at GOSH. All 3 sets were of the O’Connell Total Vertical configuration. The 2006 case (CPT 1) was a Type 1, the 2011 case (CPT 2) a Type 3 and the 2019 set (CPT 3) a Type 2 configuration. Staged separation was undertaken in all 3 cases spanning some 6 months for each case. Neurovascular separation was undertaken first and once completed, tissue expanders were inserted and the final separation undertaken. For planning the separation cross-sectional imaging, MR flow studies, Digital subtraction angiograms, 3D photogrammetry, finite element modeling, rapid prototyping, 3 D modeling, computer simulations and virtual reality holograms were utilized. Results: The 6 twins survived the separation process. From CPT 1 both girls are diagnosed on the ADHD spectrum and require extra support at school. One twin has a mild weakness on one side; she is ambulant and able to use her affected arm for gross motor skills. From CPT 2 both girls are neurologically intact. From CPT 3, one twin suffered a venous infarct resulting in a weakness in her left arm and leg. Follow up is short to comment on final recovery and cognitive outcome. All 3 sets presented with Cardiac and Renal compromise which deteriorated during the separation process and settled upon final separation. Blood shunting was a particular issue with CPT 3, made worse by thrombosis of the major draining veins of the neck and upper thorax. Positioning to allow for the skulls to open up some in an ‘open book’ fashion afforded a significant advantage to the whole process. Silastic sheets were used to define and prevent reattachment of the divided tissues and this proved most useful. Use of artificial dura prior to the final separation has the opposite effect to the silastic sheets. Dural closure between stages should be undertaken with a strip of a dural substitute to enable easier identification during reopening in subsequent stages. Tissue expanders with soft edges are preferable. Watertight dural closure is important at each stage. Conclusion: Staged separation has a lower morbidity and mortality profile for Craniopagus twins of the total vertical classification. This does require stringent, multidisciplinary planning and execution. The venous anatomy and its separation is the key.

Outcomes of Nasal Septal Perforation Repair Using Combined Temporoparietal Fascia Graft and Polydioxanone Plate Construct.

Numerous techniques are used for septal perforation repair, yet success rates remain variable. Few studies have evaluated the effectiveness of interposition grafts of polydioxanone plates combined with a temporoparietal fascia graft for septal perforation repair. To investigate and describe the use of interposition grafts of polydioxanone plates combined with a temporoparietal fascia graft for septal perforation repair and the expansion of this technique to patients with more challenging comorbidities, including granulomatosis with polyangiitis. A retrospective medical record review was performed of patients who underwent septal perforation repair using interposition grafts of polydioxanone plates combined with a temporoparietal fascia graft from January 1, 2015, to July 1, 2018, at Vanderbilt University Medical Center and from January 1, 2017, to July 1, 2018, at the University of Iowa. All patients underwent septal perforation repair with interposition grafts of polydioxanone plates and a temporoparietal fascia graft. Assessing closure of septal perforation was the primary outcome. Secondary outcomes were resolution of presenting symptoms of septal perforation, area of perforation, length of postoperative stent and silastic sheeting placement, postoperative complications and resolution, and duration of follow-up. Preoperative and postoperative Nasal Obstruction Symptom Evaluation (NOSE) scores were assessed. A total of 17 patients (12 women and 5 men; mean [SD] age, 45 [15] years) were included. The causes of perforations were iatrogenic (9 [53%]), rheumatologic (2 [12%]), and unknown or idiopathic (6 [35%]). Patients most commonly presented with nasal crusting (12 [71%]), whistling (9 [53%]), nasal obstruction (9 [53%]), and epistaxis (5 [29%]). Mean (SD) perforation size was 0.99 (1.04) cm2. Mean (SD) postoperative follow-up was 6.1 (4.1) months. A total of 15 patients (88%) had complete resolution of presenting symptoms at last follow-up. All perforations were closed with overlying mucosa at the most recent follow-up examination. Nine of 17 patients completed both preoperative and postoperative NOSE. There was a significant difference between the mean (SD) preoperative and postoperative NOSE scores (62.78 [27.74] vs 17.78 [15.83]; P = .004). Repair of symptomatic nasal septal perforations using a temporoparietal fascia graft combined with a polydioxanone plate was associated with positive outcomes. Repair of septal perforations caused by rheumatologic disease, including granulomatosis with polyangiitis, can be considered for repair using this technique. Resolution of symptoms appeared to be clinically more meaningful in evaluation of septal perforation repair than rate of perforation closure, and the NOSE scale has the potential to serve as an objective corroboration to patient-reported postoperative outcomes. 4.

Silastic "Spring" Spacers for Use Following Endoscopic Sinus Surgery.

The prevention of middle turbinate lateralization, and middle meatal synechiae formation, is the key to maintain a patent ostiomeatal complex following endoscopic sino-nasal surgery (ESS). Different techniques have been described to prevent this undesirable outcome, however, most of them are invasive, expensive, uncomfortable and/or obstructive. We present our technique to modified silastic sheets to circumvent these problems and improve ventilation and drainage of sinuses after surgery. The aim of this paper is to present how this silastic sheeting can be easily customized to the shape of the ethmoid cavity after ESS, allowing for ventilation of the aerated sinonasal cavities and at the same time preventing problematic synechiae/scar formation. A practical and easy technique to customize silastic stents following ESS is presented. Silastic sheets could be easily customized of the ethmoid cavity after ESS providing an excellent alternative to reduce middle turbinate lateralization and synechiae formation.

A retrospective study comparing treatment outcomes of spontaneous healing, scaffolding with silastic sheet and gelfoam in patients with traumatic tympanic membrane perforations

<p class="abstract"><strong>Background:</strong> Objective of the study was to compare the treatment outcome of conservative management, intervention with silastic sheet and gelfoam mixed with autologous blood in traumatic perforations of tympanic membrane.</p><p class="abstract"><strong>Methods:</strong> A retrospective study was conducted on 69 patients; with traumatic ear perforation were treated by conservative management, silastic sheet placement and gelfoam with autologous blood. Patients data every week and minimum of 4 visits was documented. On follow up data was reassessed in terms of symptom improvement, healing of perforation, duration for healing and development of secondary infection. Statistical analysis was done using Fischer’s exact test. </p><p class="abstract"><strong>Results:</strong> Out of the 69 patients group1 consisted of 38 patients, group2 had 19 and group3 had 12 patients. The age ranged from 02-72 years, with greater incidence in females. In group 1 though the healing rate was very good symptom improvement was gradual. The symptom improvement in both group 2 and 3 were satisfactory and highly significant p<0.001. The difference in healing outcome of three modality of treatments was found significant p<0.05 but the occurrence of infection and local reaction did not affect the healing outcome at the end p<0.05.</p><strong>Conclusions:</strong> Traumatic TM perforations have a high chance of healing. Treatment outcome should not consider only healing status as a sole measure but symptom relief from distressing symptoms like ear buzzing or tinnitus and hearing loss should also be considered. Use of scaffolding method can be useful in such cases. Hence selection of proper treatment modality should be considered based on patient complaints.

Use of a pre-vascularised oral mucosal cell sheet for promoting cutaneous burn wound healing.

Pre-vascularised cell sheets have been used to promote early angiogenesis and graft survival. However, the use of pre-vascularised mucosal cell sheets for burn wounds has been rarely evaluated. Therefore, we examined the applicability of an oral pre-vascularised mucosal cell sheet that we had previously developed for the treatment of cutaneous burn wounds.Methods: Mucosal keratinocytes, fibroblasts, and endothelial progenitor cells were isolated from the oral mucosa and peripheral blood and were expanded in vitro. Mucosal cell sheets were generated by seeding cultured keratinocytes onto a mixture of fibroblasts, endothelial cells, and fibrin. Third-degree burn wounds were created on the backs of rats and were covered with the cell sheets, skin grafts, or silastic sheets as a control. Gross and microscopic findings and gene expression profiles of wounds were compared among the groups.Results: CD31-positive microvessels were observed in the fibrin-matrix layer of the cell sheet. In the cutaneous burn wound model, the cell sheets promoted wound healing, with accelerated wound closure and less scarring than with silastic sheets and skin grafts. The cell sheets had more microvessels and proliferating cells and less neutrophil infiltration and fibrotic features than the controls or skin grafts. The cell sheet induced higher mRNA expression of KRT14, VEGFA, IL10, and AQP3 and lower mRNA expression of TGFB1, IL6, ICAM1, ACTA2, and FN1 than did the controls or skin grafts.Conclusions: The pre-vascularised mucosal cell sheet promotes cutaneous burn wound healing.

Contracted Nose Correction with Dermofat and Conchal Cartilage.

Contracted Nose Correction with Dermofat and Conchal Cartilage.

Healing of the nasal septal mucosa in an experimental rabbit model of mucosal injury.

ObjectiveThe aim of this study was to investigate the regeneration process of the nasal mucosa after a surgically created mucosal defect in the rabbit nasal septum, and to evaluate the effects of different interventions.MethodsA 7 mm-diameter circular mucosal defect was made in the septum of forty New Zealand white rabbits. The rabbits were divided into four groups (ten rabbits in each group) according to the type of intervention; no treatment (control), silastic sheet (SS), hyaluronic acid (HA), and silastic sheet and hyaluronic acid (SS + HA) group. The diameter of the defect, mucosal thickness, epithelial thickness, and ciliated cell count were evaluated every week for five weeks.ResultsThe average diameter of the defect in the control group were 5.1, 3.65, 1.2, 0.75, and 0.05 mm at postoperative 1, 2, 3, 4, and 5 weeks. In the SS group, the diameter decreased to 4.35, 2.1, 0.35, 0.15, and 0 mm at postoperative 1, 2, 3, 4, and 5 weeks, respectively, in which the mean diameter of the postoperative week 2 was significantly smaller compared to control (3.65 mm vs. 2.1 mm, P = 0.039). For the HA group and SS + HA group, the diameter of the defect did not show a significant difference from the control group during the five weeks. The mucosal thickness, epithelial thickness, and ciliated cell count of the regenerated mucosa were not significantly different among the groups.ConclusionThe regeneration process of the nasal septal mucosa was identified using a novel rabbit model. Mucosal regeneration can be accelerated by applying silastic sheets.

Middle cranial fossa approach to repair tegmen defects assisted by three-dimensionally printed temporal bone models.

To explore the perioperative utility of three-dimensionally (3D)-printed temporal bone models of patients undergoing repair of lateral skull base defects and spontaneous cerebrospinal fluid leaks with the middle cranial fossa approach. Case series. 3D-printed temporal bone models-based on patient-specific, high-resolution computed tomographic imaging-were constructed using inexpensive polymer materials. Preoperatively, the models demonstrated the extent of temporal lobe retraction necessary to visualize the proposed defects in the lateral skull base. Also preoperatively, Silastic sheeting was arranged across the modeled tegmen, marked, and cut to cover all of the proposed defect sites. The Silastic sheeting was then sterilized and subsequently served as a precise intraoperative template for a synthetic dural replacement graft. Of note, these grafts were customized without needing to retract the temporal lobe. Five patients underwent the middle cranial fossa approach assisted by 3D-printed temporal bone models to repair tegmen defects and spontaneous cerebrospinal fluid leaks. No complications were encountered. The prefabricated dural repair grafts were easily placed and fit precisely onto the middle fossa floor without any additional modifications. All defects were covered as predicted by the 3D temporal bone models. At their postoperative visits, all five patients maintained resolution of their spontaneous cerebrospinal fluid leaks. Inexpensive 3D-printed temporal bone models of tegmen defects can serve as beneficial adjuncts during lateral skull base repair. The models provide a panoramic preoperative view of all tegmen defects and allow for custom templating of dural grafts without temporal lobe retraction. 4 Laryngoscope, 127:2347-2351, 2017.

Nasal septum configuration as a basis for novel septal splints.

The objective is to use anatomical determinations of nasal septum shape and surface area in adults as a design basis for silastic septal splints of universal size and fit and offering maximum possible surface coverage. The objective is also to devise a method of securing the septal splints, so that surface pressure on septal mucosa is distributed as evenly as possible while not interfering with capillary perfusion. Nasal septum area was determined in 21 Caucasian body donors, and nasal septum thickness was measured in 20 CT scans. Septal splints of universal size and shape were prepared from silastic sheeting. The holding force of various neodymium-iron-boron (NdFeB) magnets, and the surface pressure exerted by magnet-containing septal splints was calculated. These septal splints of novel design offer a satisfactory fit in routine clinical practice. The splints can be securely attached with built-in NdFeB magnets, and surface pressure can be distributed evenly across the nasal septum while not interfering with mucosal tissue perfusion. With their simple intranasal insertion, these magnet-containing septal splints of universal size and optimised shape offer maximum possible septum coverage following septoplasty/septorhinoplasty. The absence of interference with septal tissue perfusion means that they are likely to be associated with fewer postoperative complications and better outcomes.

Correction of Medial Blowout Fractures According to the Fracture Types.

Regarding the issue of blowout fracture, a variety of approaches and surgical techniques have been reported to improve postoperative results. However, there are no extant guidelines for the selection of these various methods. The current authors classified the medial blowout fracture into 3 different types and adapted to suitable surgical techniques. Between October 2010 and March 2013, 89 patients who had medial blowout fracture were included in this study. We classified the study patients into 3 different categories: greenstick, simple, and complex. The greenstick type used the transnasal endoscopic approach and was reduced with packing after applying a silastic sheet. The simple type used an onlay covering technique. The complex type was treated using the transcaruncular approach and inlay implanting technique. After surgery, the continuity of orbital wall was checked by computed tomography. Patients were then examined for the following conditions: diplopia, eyeball movement, and enophthalmos. The greenstick category consisted of 12 cases, most cases were satisfied. One case relapsed after removal of the packing. In the simple category, a total of 9 cases were treated by onlay covering technique. In all 68 cases of the complex type, we could obtain suitable anatomical reconstruction with inlay implanting technique. Only 2 cases complained of transient diplopia and moderate enophthalmos. Appropriate clinical classification, depending on the type of fracture and selection of optimal treatment methods, could obtain the satisfactory result and improve the treatment outcomes in the correction of medial orbital wall fracture.

레이저 수술 후에 생긴 전연합부 협착의 실리콘 판을 이용한 치료 1예

레이저 수술 후에 생긴 전연합부 협착의 실리콘 판을 이용한 치료 1예

The effects of topical agents on paranasal sinus mucosa healing: a rabbit study.

Numerous topical agents have been used intraoperatively to enhance postoperative mucosal healing or reduce scar formation. However, the histological effects of many of these treatments have not been well described. This study investigates the impact of topical mometasone furoate, acitretin, lactoferrin, and Silastic sheet (Medtronic) on sinus mucosal healing in a rabbit model. Forty-eight New Zealand white rabbits underwent defined, localized stripping of a bilateral region of maxillary sinus mucosa. One of 6 treatments was placed in 1 maxillary sinus, and the treatment carrier was applied contralaterally (0.1% mometasone furoate, 0.25% and 0.5% acitretin, lactoferrin, Silastic, and no treatment; n = 8 each group). Rabbits were euthanized after 2 weeks and histological sections were examined with light microscopy. Treatment with acitretin 0.25% and 0.5% improved cilial recovery by 0.9 ± 0.5 (p = 0.003) and 0.5 ± 0.5 (p < 0.05), respectively. Acitretin 0.25% treatment also significantly reduced collagen in healing mucosa (5.1% ± 4.8%, p = 0.04). Conversely, rabbits treated with mometasone furoate 0.1% were more likely to have reduced cilial and goblet cell recovery. Intergroup comparisons demonstrated a significant improvement in cilial recovery scores with both acitretin doses compared with mometasone furoate (p < 0.05) and less collagen deposition in rabbits treated with placebo gel over Silastic (p < 0.05). Mucosa directly underlying a blood clot had a lower cilia score and impaired epithelial recovery (p < 0.001). Intraoperatively applied agents have the potential to significantly affect wound healing. Acitretin improved cilial recovery and reduced collagen deposition.

Endoscopic endonasal surgery in orbital decompression and orbital reconstruction

Objectiv The aim of this study was to clarify and evaluate the role and the outcome of endoscopic endonasal surgery in both orbital decompression and orbital reconstruction. Background Traditional external techniques are now known to reduce proptosis significantly, but have the disadvantage of cosmetic morbidity in terms of a cutaneous scar and a high incidence of postoperative complications. Recent advances in endoscopic sinus surgery have extended its applications beyond the nose to the orbit. Orbital decompression, drainage of subperiosteal abscess, optic nerve decompression, and orbital wall reconstruction are performed very safely and effectively by endoscopic intranasal surgery. Patients and methods Fifty-four patients indicated for endoscopic orbital decompression or reconstruction were divided according to the cause into five groups (20 infection, eight inflammatory, eight neoplastic, eight congenital, and 10 traumatic). Preoperative evaluations performed were history taking, physical examination, and computed tomography and MRI of orbit and paranasal sinuses. After creating an endoscopic wide middle meatal antrostomy dealing with the pathology causing extraconal orbital compression and in intraconal compression penetrate the lamina papyracea and periosteum until prolapsed fat fill the ethmoid sinus. Reconstruction was performed by removal of the fractured bone, extraocular muscle reposition with support using Foley's catheter in floor fracture and a silastic sheet with Merocel packing in medial wall fracture. Results There was significant proptosis reduction in all groups, especially in the infection group ( P P Conclusion Endoscopic nasal decompression of the orbit is a safe and effective approach for reducing proptosis and improving vision and ocular motility in cases of orbital compression, which include infection, inflammatory, neoplastic, congenital, and traumatic causes. Endoscopic intranasal reduction of the orbital floor with a Foley's catheter balloon and with a silastic sheet and Merocel packing of the medial orbital wall provided good functional results and definite advantages. Complications were limited.

A Case of Successful Endoscopic Dacryocystorhinostomy in Nasolacrimal Duct Obstruction with Wegener Granulomatosis

Purpose: To report a case of nasolacrimal duct obstruction occurring in a patient with Wegener granulomatosis treated successfully with endoscopic dacryocystorhinostomy. Case summary: A 36-year-old female diagnosed with Wegener’s granulomatosis 3 years prior and treated with rituximab and currently taking azathioprine 100 mg presented with a 1-year history of left epiphora and mucus in the left eye. Her left tear meniscus was higher than the right and was a hard stop with lacrimal probe when a lacrimal probing test was performed. Mucus was regurgitated during lacrimal irrigation and middle turbinate was not observed due to granuloma in the nasal cavity. Dacryocystography showed proximal nasolacrimal duct obstruction and a well-defined dacryocystocele 6 x 5 x 6 mm in size was observed on the left lacrimal fossa on facial 3D computed tomography. After synechiolysis for a granuloma in the nasal cavity, endoscopic dacryocystorhinostomy was performed and silastic sheet sutured on the nasal septum to prevent resynechia. After 2 weeks and 4 months, the silastic sheet and silicon tube were removed, respectively. The patient was asymptomatic following surgery and there was no regurgitation during lacrimal irrigation test. The ostium was patent at 5 months after surgery using the endoscopic dye test. Conclusions: Nasolacrimal duct obstruction occurring in a patient with Wegener’s granulomatosis can be treated effectively with endoscopic dacryocystorhinostomy even if the nasal cavity is narrow due to granuloma. J Korean Ophthalmol Soc 2015;56(9):1454-1458

Endoscopic V/s External Approach DCR: A comparative Analysis

Aims & Objective: To compare the surgical procedures, intra-operative & post operative complications and overall success rate of Endoscopic Dacrocystorhinostomy (Endo-DCR) with External approach Dacrocystorhinostomy (DCR). Materials & Methods: In this randomized, interventional, comparative study, 50 cases of mechanical Endonasal Dacrocystorhinostomy & 30 cases of conventional External Dacrocystorhinostomy were performed from January 2006 to April 2007 in the department of Ophthalmology in conjunction with department of Otorhinolaryngology, Sir Sunder Lal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh. All patients underwent detailed general, medical and ocular history as well as thorough ocular and ENT examination to rule out any nasal pathology. Level of blockage was diagnosed by lacrimal syringing & probing, Jones dye test and dacrocystography. Surgery was done under local anesthesia except in children and uncooperative patients where general anesthesia was used. For Endo- DCR surgery, 0 & 30 degree rigid endoscope was used. In selected cases silastic sheet were used. The surgical outcomes and complications were analyzed. Results: Functional success and symptomatic relief were equivalent in both procedures. Endo-DCR surgery was found to be quicker to perform than external DCR surgery. The follow-up duration was comparable in both groups. Patient satisfaction was significantly higher in the Endo -DCR group. Conclusion: Endo-DCR surgery offers a very attractive alternative to the well established technique of external DCR surgery for the treatment of primary acquired nasolacrimal duct obstruction with equivalent success rates, shorter surgical time and higher patient satisfaction. Keywords: Chronic dacryocystitis, Endoscopic DCR, Epiphora, Endonasal DCR surgery, External DCR, Silicon intubation

Use of silastic sheets with mattress-fashion sutures for the treatment of auricular hematoma.

Laryngoscope, 125:730–732, 2015