Endonasal dacryocystorhinostomy: evaluation of the anatomical and functional results

Authors

  • Kanchan Tadke Department of ENT, Government Medical College, Nagpur, Maharashtra, India
  • Vaibhav Lahane Department of ENT, Government Medical College, Nagpur, Maharashtra, India
  • Akshay Sarode Department of ENT, Government Medical College, Jalgoan, Maharashtra, India
  • Nitish . Department of ENT, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20200628

Keywords:

Nasolacrimal duct obstruction, Endoscopic dacryocystorhinostomy, Neo-ostium

Abstract

Background: Dacryocystorhinostomy is a novel surgical technique for NLD obstruction performed by external and endonasal approach. Both procedures have variable success rates and advantages or disadvantages. The objectives were to study functional and anatomic outcomes of endoscopic DCR and to assess degree of ostium shrinkage in postoperative period.

Methods: Prospective study comprising 68 patients of NLD obstruction with 70 procedures performed during the period of October 2014 to October 2016. Various dimensions of bony neo-ostium were recorded intraoperatively and during 1st and 3rd month follow up. Mitomycin C was applied in 37 cases. Degree of ostium shrinkage and its correlation with surgical success was studied. Outcome of study was measured as functional and anatomical success.  

Results: 68 patients in age range of 7 to 71 years. Mean intraoperative height and width were 12.0±2.08 mm and 5.17±0.82 mm respectively and intraoperative surface area of ostium was 62.77±17.27mm2. The study showed strong positive correlation between initial and final ostium size. The final ostium irrespective of its size, if patent does not result in recurrence of symptoms and can be considered as success. In the present study, functional and anatomical success was 97.14% and failure rate was 2.86%.

Conclusions: Both functional and anatomical success require creation of patent neo-ostium, although the intraoperative size of ostium is not the deciding factor for final outcome. Complete exposure of lacrimal sac, adequate mucosal preservation, good marsupialization and mucosal apposition are the some of the crucial factors responsible for stable ostium patency and hence the surgical success.

References

Ozer S, Ozer PA. Endoscopic vs external dacryocystorhinostomy-comparison from the patients' aspect. Int J Ophthalmol. 2014;7(4):689-96.

Jutley G, Karim R, Joharatnam N, Latif S, Lynch T, Olver JM. Patient satisfaction following endoscopic endonasal dacryocystorhinostomy:a quality of life study. Eye. 2013;27(9):1084-9.

Sadiq SA, Ohrlich S, Jones NS, Downes RN. Endonasal laser dacryocystorhinostomy-medium term results. Br J Ophthalmol. 1997;81(12):1089-92.

Tsirbas A, Wormald PJ. Mechanical Endonasal Dacryocystorhinostomy with Mucosal Flaps. Otolaryngol Clin N Am. 2006;39(5):1019-36.

Zaidi FH, Symanski S, Olver JM. A clinical trial of endoscopic vs external dacryocystorhinostomy for partial nasolacrimal duct obstruction. Eye (London, England). 2011;25(9):1219-24.

Ben Simon GJ, Joseph J, Lee S, Schwarcz RM, McCann JD, Goldberg RA. External versus endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction in a tertiary referral center. Ophthalmology. 2005;112(8):1463-8.

Hartikainen J, Grenman R, Puukka P, Seppä H. Prospective randomized comparison of external dacryocystorhinostomy and endonasal laser dacryocystorhinostomy. Ophthalmology. 1998;105(6):1106-13.

Tarbet KJ, Custer PL. External dacryocystorhinostomy. Surgical success, patient satisfaction and economic costs. Ophthalmology. 1995;102:1065-70.

Walland MJ, Rose GE. The effect of silicone intubation on failure and infection rates after dacryocystorhinostomy. Ophthalmic Surg. 1994;25:597-600.

Konuk O, Kurtulmusoglu M, Knatova Z, Unal M. Unsuccessful lacrimal surgery:causative factors and results of surgical management in a tertiary referral center. Ophthalmologica. 2010;224:361-6.

Linberg JV, Anderson RL, Bumsted RM, Barreras R. Study of intranasal ostium external dacryocystorhinostomy. Arch Ophthalmol. 1982;100(11):1758-62.

Argin A, Görür K, Ozcan C, Arslan E, Ozmen C, Vayisoglu Y.The role of larger osteotomy in long term success in external dacryocystorhinostomy. J Plast Reconstr Aesthet Surg. 2008;61(6):615-9.

Mann BS, PJ Wormold. Endoscopic Assessment of the Dacryocystorhinostomy Ostium after Endoscopic Surgery. Laryngoscope. 2006;116:1172-4.

Ben Simon GJ, Brown C, McNab AA. Larger osteotomies result in larger ostia in external dacryocystorhinostomies.. Arch Facial Plast Surg. 2012;14(2):127-31.

Pittore B, Tan N, Salis G, Brennan PA, Puxeddu R. Endoscopic transnasal dacryocystorhinostomy without stenting: results in 64 consecutive procedures. Acta Otorhinolaryngol Ital. 2010;30(6):294-8.

Ramakrishnan VR, Hink EM, Durairaj VD, Kingdom TT. Outcomes after endoscopic dacryocystorhinostomy without mucosal flap preservation. Am J Rhinol. 2007;21:753-7.

Yigit O, Samancioglu M, Taskin U, et al. External and endoscopic dacryocystorhinostomy in chronic dacryocystitis:comparison of results. Eur Arch Otorhinolaryngol. 2007;264:879-85

Barbara Z, Tritten JJ, Friedrich JP, Monnier P. Analysis of functional and anatomic success following endonasal dacryocystorhinostomy. Ann Otol Rhinol Laryngol. 2011;120(4):231-8.

Ahmed EG, Dorgham AGM. Endoscopic revision surgery for recurrent epiphora occurring after external dacryocystorhinostomy. Ann Otol Rhinol Laryngol. 2000;109(4):425-30.

Jin HR, Choi JC, Moon YE, Kim MS, Oh JK, Kim HA, et al. The surgical outcome of endoscopic dacryocystorhinostomy according to the obstruction levels of lacrimal drainage system. Clin Experimental Otorhinolaryngol. 2009;2(3):141-4.

Weidenbecher M, Hosemann W, Buhr W. Endoscopic endonasal dacryocystorhinostomy: Results in 56 patients. Ann Otol Rhinol Laryngol. 1994;103:363-7.

Hartikainen J, Lehtonen O, Saari KM. Bacteriology of lacrimal duct obstruction in adults. Br J Ophthalmol. 1997;81(1):37-40.

Woog JJ. Obstruction of the lacrimal drainage system. Curr Opin Ophthalmol. 2002;13(5):303-9.

Beigi B, Uddin JM, McMullan TFW, Linardos E. Inaccuracy of diagnosis in a cohort of patients on the waiting list for dacryocystorhinostomy when the diagnosis was made by only syringing the lacrimal system. Eur J Ophthalmol. 2007;17(4):485-9.

Figueira E, Abbadi ZA, Malhotra R, Wilcsek G, Selva D. Frequency of simultaneous nasal procedures in endoscopic dacryocystorhinostomy. Ophthal Plast Reconstr Surg. 2014;30:40-3.

Nussbaumer M, Schreiber S, Yung MW. Concomitant nasal procedures in endoscopic dacryocystorhinostomy. J Laryngol Otol 2004;118:267-9.

Ali MJ, Psaltis AJ, Wormald PJ. The Frequency of Concomitant Adjunctive Nasal Procedures in Powered Endoscopic Dacryocystorhinostomy. Orbit. 2015;34(3):142-5.

Chan W, Selva D. Ostium shrinkage after endoscopic dacryocystorhinostomy. Ophthalmology. 2013;120(8):1693-6.

Davies MJ, Lee S, Lemke S, Ghabrial R. Predictors of anatomical patency following primary endonasal dacryocystorhinostomy:a pilot study. Orbit (Amsterdam, Netherlands). 2011;30(1):49-53.

Mannor GE, Millman AL. The prognostic value of preoperative dacryocystography in endoscopic intranasal dacryocystorhinostomy. Am J Ophthalmol. 1992;113:134-7.

Hammoudi DS, Tucker NA. Factors associated with outcome of endonasal dacryocystorhinostomy. Ophthal Plast Reconstr Surg. 2011;27:266-9.

Cheng S, Feng Y, Xu L, Li Y, Huang J. Efficacy of Mitomycin C in Endoscopic Dacryocystorhinostomy: A Systematic Review and Meta Analysis. PLoS ONE. 2013;8(5):e62737.

You YA, Fang CT. Intraoperative mitomycin C in dacryocystorhinostomy. Ophthal Plast Reconstr Surg. 2001;17:115-9.

Tirakunwichcha S, Aeumjaturapat S, Sinprajakphon S. Efficacy of mitomycin C in endonasal endoscopic dacryocystorhinostomy. Laryngoscope. 2011;121:433-6.

Kao SC, Liao CL, Tseng JH, Chen MS, Hou PK. Dacryocystorhinostomy with intraoperative Mitomycin C. Ophthalmology. 1997;104:86-91.

Neuhaus RW Baylis HI. Cerebrospinal fluid leakage after dacryocystorhinostomy. Ophthalmology. 1983;90(9):1091-5.

Fayet B, Racy E AM. Cerebrospinal fluid leakage after endonasal dacryocystorhinostomy. J Fr Ophtalmol. 2007;30(2):129-34.

Yung MW, Hardman-Lea S. Analysis of the results of surgical endoscopic dacryocystorhinostomy: Effect of the level of obstruction. Br J Ophthalmol. 2002;86(7):792-4.

Sinha V, Gupta D, Prajapati B, More Y, Khandelwal P, Singh SN, et al. Endoscopic dacryocystor-hinostomy with conventional instruments: Results and advantages over external dacryocystor-hinostomy. Indian J Otolaryngol Head Neck Surg. 2008;60(3):207-9.

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Published

2020-02-24

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Original Research Articles