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Pace GM, Giombi F, Muci G, Giunta G, Pirola F, Serra E, Zuppardo J, Ferreli F, Vinciguerra P, Mercante G, Maria AD, Spriano G, Malvezzi L. Outcomes of Endoscopic Endonasal Dacryocystorhinostomy in Glaucoma Patients. J Pers Med 2024; 14:348. [PMID: 38672975 PMCID: PMC11050967 DOI: 10.3390/jpm14040348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Anti-glaucoma eye drops have been investigated due to their production of fibrotic changes on the conjunctival surface, undermining the functioning of the upper lacrimal drainage system. We aimed to assess whether these effects may impair the effectiveness of endoscopic endonasal dacryocystorhinostomy (EE-DCR). METHODS This is a single-center observational retrospective study on EE-DCR via a posterior approach. Resolution of epiphora and dacryocystitis were analyzed after 1 (T1) and 6-months (T2) from surgery. Surgical success was defined as anatomical (patency at irrigation, no recurring dacryocystitis) or complete (zeroing of Munk score). RESULTS Twenty patients (32 sides) were enrolled. Preoperatively, 93.75% (n = 30/32) presented severe (Munk 3-4) epiphora and 68.75% (n = 22/32) recurrent dacryocystitis. At T1, 50.0% (n = 16/32) were referred with residual epiphora (Munk ≥ 1) and 18.75% (n = 6/32) dacryocystitis. At T2, 31.25% (n = 10/32) still complained of epiphora (Munk ≥ 1) and 6.25% (n = 2/32) dacryocystitis. Difference of outcomes at aggregate and paired timepoints (except for T1 versus T2) resulted in statistical significance (p < 0.05). At T2, 22 (68.75%) complete, 8 (25.0%) anatomical successes and 2 (6.25%) surgical failures were observed. CONCLUSIONS Despite the chronic uptake of anti-glaucoma eye drops, EE-DCR guaranteed high rates of clinical relief from epiphora and remarkable decreases in the rates of recurrent dacryocystitis.
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Affiliation(s)
- Gian Marco Pace
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.M.P.); (G.M.); (G.G.); (E.S.); (J.Z.); (F.F.); (P.V.); (G.M.); (A.D.M.); (G.S.); (L.M.)
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Francesco Giombi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.M.P.); (G.M.); (G.G.); (E.S.); (J.Z.); (F.F.); (P.V.); (G.M.); (A.D.M.); (G.S.); (L.M.)
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Giovanna Muci
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.M.P.); (G.M.); (G.G.); (E.S.); (J.Z.); (F.F.); (P.V.); (G.M.); (A.D.M.); (G.S.); (L.M.)
| | - Gianmarco Giunta
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.M.P.); (G.M.); (G.G.); (E.S.); (J.Z.); (F.F.); (P.V.); (G.M.); (A.D.M.); (G.S.); (L.M.)
| | - Francesca Pirola
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Egidio Serra
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.M.P.); (G.M.); (G.G.); (E.S.); (J.Z.); (F.F.); (P.V.); (G.M.); (A.D.M.); (G.S.); (L.M.)
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Jessica Zuppardo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.M.P.); (G.M.); (G.G.); (E.S.); (J.Z.); (F.F.); (P.V.); (G.M.); (A.D.M.); (G.S.); (L.M.)
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Fabio Ferreli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.M.P.); (G.M.); (G.G.); (E.S.); (J.Z.); (F.F.); (P.V.); (G.M.); (A.D.M.); (G.S.); (L.M.)
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Paolo Vinciguerra
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.M.P.); (G.M.); (G.G.); (E.S.); (J.Z.); (F.F.); (P.V.); (G.M.); (A.D.M.); (G.S.); (L.M.)
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.M.P.); (G.M.); (G.G.); (E.S.); (J.Z.); (F.F.); (P.V.); (G.M.); (A.D.M.); (G.S.); (L.M.)
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Alessandra Di Maria
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.M.P.); (G.M.); (G.G.); (E.S.); (J.Z.); (F.F.); (P.V.); (G.M.); (A.D.M.); (G.S.); (L.M.)
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.M.P.); (G.M.); (G.G.); (E.S.); (J.Z.); (F.F.); (P.V.); (G.M.); (A.D.M.); (G.S.); (L.M.)
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Luca Malvezzi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.M.P.); (G.M.); (G.G.); (E.S.); (J.Z.); (F.F.); (P.V.); (G.M.); (A.D.M.); (G.S.); (L.M.)
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
- Otorhinolaryngology Head and Neck Surgery Unit, Casa di Cura Humanitas San Pio X, Via Francesco Nava 31, 20159 Milan, Italy
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Rikhtehgar MH, Rikhtehgar MJ, Hassanpour K, Aletaha M, Veisi A. Clinical outcomes of endoscopic dacryocystorhinostomy without preserving mucosal flaps in combination with silicone stent and steroid-soaked gelfoam. J Fr Ophtalmol 2024; 47:104013. [PMID: 37932172 DOI: 10.1016/j.jfo.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/09/2023] [Accepted: 07/03/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE To report clinical outcomes of endoscopic dacryocystorhinostomy (En-DCR) combined with stenting and without preserving the nasal and lacrimal mucosal flaps. METHODS In this prospective interventional case series, patients with primary acquired nasolacrimal duct obstruction who were candidates for En-DCR were enrolled. Patients with a known history of previous DCR, sinus surgery, rhinoplasty, nasal trauma, nasal anomaly, canalicular or punctal occlusion, or less than one year of follow-up were excluded. All patients underwent En-DCR and stenting followed by ostial packing using Gelfoam soaked with dexamethasone. The patients were assessed preoperatively, on the first postoperative day, after 2 weeks, 3 months, and 1 year. Postoperative outcomes were anatomical and functional success, defined as patent irrigation test and resolution of epiphora, respectively. The nasolacrimal drainage system was evaluated anatomically and functionally during the follow-up period. RESULTS Eighty-three patients with a mean age of 54.36±15.27 years were enrolled. Of these, 61 patients (73.5%) were women. The mean duration of follow-up was 20.7±6.9 months. Anatomical success was achieved in all patients and remained stable during the study duration and at 1 year. Functional failure leading to epiphora was observed in 1 patient 3 months after surgery and resolved after re-DCR at year 1. Preoperative tenderness and purulent reflux were observed in 12%, 33.7% of which completely resolved postoperatively. Moderate and severe hemorrhage was observed in 12 (14.5%) and 2 (2.4%) patients, respectively. CONCLUSION En-DCR without mucosal flap preservation in combination with silicone stent and steroid-soaked Gelfoam is a safe and highly successful procedure in patients with primary acquired nasolacrimal duct obstruction.
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Affiliation(s)
- M H Rikhtehgar
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of medical sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of medical sciences, Tehran, Iran
| | - M J Rikhtehgar
- Department of ophthalmology, Torfeh Eye Hospital, Shahid Beheshti University of medical sciences, Tehran, Iran
| | - K Hassanpour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of medical sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of medical sciences, Tehran, Iran
| | - M Aletaha
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of medical sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of medical sciences, Tehran, Iran
| | - A Veisi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of medical sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of medical sciences, Tehran, Iran.
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Chacko A, J.K. Y. Comparative Study of Endonasal Endoscopic Dacryocystorhinostomy with or without Preservation of Nasal Mucosal Flap. Indian J Otolaryngol Head Neck Surg 2024; 76:894-898. [PMID: 38440443 PMCID: PMC10908912 DOI: 10.1007/s12070-023-04311-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/20/2023] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVE To analyse the result of endoscopic endonasal dacryocystrhinostomy with or without preservation of nasal mucosal flap. STUDY DESIGN Randomised prospective cohort design. SETTING Tertiary academic centre. SUBJECTS AND METHODS 100 patients who presented with epiphora and diagnosed as chronic dacryocystitis after syringing by ophthalmologist, were selected and randomised into two groups. Standard surgical procedure of endoscopic endonasal dacryocystorhinostomy was carried out except for the preservation of flap in group A and without preservation of flap in group B. Additional surgeries were done according to necessity. Postoperatively, patients were followed up on OPD-basis at the end of 1st week, 2nd week, 1st month, and 3rd month. Symptomatic improvement was assessed and patency checked by syringing by the ophthalmologist. RESULTS Nil intraoperative complications (p < 0.05) and nil postoperative complication noted (p < 0.05). Functional and anatomical patency found to be 100% at the end of 1st week in both groups, 96% at 3rd month in case group A and 98%, 92% and 82% respectively at the end of 2nd week, 1st month and 3rd month in group B. Nasal endoscopy of all surgical failures showed restenosis in both groups and synechiae in 2 patients in group B. CONCLUSIONS Preservation of nasal mucosal flap with modification around stoma can be used to cover the bared bone with avoidance of granulation tissue formation reducing the risk of closure of ostium with large rhinostomy and improve success of endoscopic endonasal DCR.
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Affiliation(s)
- Aneena Chacko
- Department of ENT, Amala Institute of Medical sciences, Kerala, 680555 India
| | - Yashveer J.K.
- Department of ENT, Gandhi Medical College and Associated Hospital, Bhopal, MP 462001 India
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Tadke K, Lahane V, Lokhande P. Ostium Characteristics and Its Relevance in Successful Outcome Following Endoscopic Dacryocystorhinostomy. Indian J Otolaryngol Head Neck Surg 2022; 74:900-910. [PMID: 36452842 PMCID: PMC9702263 DOI: 10.1007/s12070-020-01970-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022] Open
Abstract
Study aims to assess the postoperative ostium shrinkage pattern and also attempted to evaluate various ostium parameters and their impact on surgical outcome by using DOS scoring system. Prospective study comprising 44 patients of NLD obstruction with 52 procedures performed during October 2016 to November 2018. Various dimensions of bony neo-ostium were recorded intraoperatively and during 1st, 3rd and 6th month follow up. Degree of ostium shrinkage and its correlation with anatomical and functional success was studied. DCR ostium (DOS) scoring system, comprised of ten various ostium parameters, was used to evaluate postoperative ostium. Intraoperative mean ostium height and width were 13.67 ± 2.76 mm and 7.0 ± 1.94 mm and surface area was 98.33 ± 38.46 mm2. Maximum ostium shrinkage (by 66.93%) occurred at 1 month and after which, average size of ostium was quite stable with little change. The anatomical and functional success rate was 94.23% and failure rate was 5.77%. DOS score was "excellent" in 40(75.92%), "good" in 9(17.31%) and "poor" in 3(5.77%) cases. Meticulous evaluation at regular intervals is important for surgeon to understand the characters of ostium during healing and also helps in early detection of pathologies and may facilitate early corrective intervention. We believe that DOS system provides an effective protocol to standardize the ostium evaluation. The ostium parameters with favourable surgical outcome are ostium location anterior to axilla of MT, circular/ oval shape with shallow base, size > 8 × 5 mm, clearly visualized and dynamic ICO, absence of ostium cicatrization, granulomas, synechiae and other pathologies.
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Affiliation(s)
- Kanchan Tadke
- Department of ENT, Government Medical College, Nagpur, Maharashtra India
| | - Vaibhav Lahane
- Department of ENT, Government Medical College, Nagpur, Maharashtra India
| | - Priyanka Lokhande
- Department of ENT, Government Medical College, Nagpur, Maharashtra India
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Cong T, Wu Y, Gao Y, Wang Q, Qin Y. Modified Endoscopic Dacryocystorhinostomy: A Clubhead-Shaped Nasal Mucoperiosteal Flap Technique. Laryngoscope 2022; 132:2314-2318. [PMID: 35837882 DOI: 10.1002/lary.30265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/16/2022] [Accepted: 06/06/2022] [Indexed: 11/08/2022]
Abstract
A modified endoscopic dacryocystorhinostomy technique using a clubhead-shaped nasal flap combined with a posteriorly hinged lacrimal flap was designed for tension-free anastomosis with the surrounding mucoperiosteum. This technique showed satisfactory outcomes that facilitated the maintenance of the rhinostomy in eight cases with nasolacrimal duct obstruction. Laryngoscope, 2022.
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Affiliation(s)
- Tiechuan Cong
- Department of Otolaryngology-Head & Neck Surgery, Peking University First Hospital, Beijing, China
| | - Yuan Wu
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | - Ying Gao
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | - Quangui Wang
- Department of Otolaryngology-Head & Neck Surgery, Peking University First Hospital, Beijing, China
| | - Yong Qin
- Department of Otolaryngology-Head & Neck Surgery, Peking University First Hospital, Beijing, China
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Magomedov MM, Atkova EL, Krakhovetskiy NN, Maydanova AA, Magomedova NM. [Modern methods in treatment of lacrimal system vertical part obliteration]. Vestn Otorinolaringol 2021; 86:86-94. [PMID: 34499454 DOI: 10.17116/otorino20218604186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A review of the literature is devoted to the description of modern methods in treatment of lacrimal system vertical part obliteration. Particular attention is paid to various aspects of the most common surgical intervention - endonasal endoscopic dacryocystorhinostomy.
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Affiliation(s)
- M M Magomedov
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
| | - E L Atkova
- The Research Institute of eye Diseases, Moscow, Russia
| | | | - A A Maydanova
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia.,The Research Institute of eye Diseases, Moscow, Russia
| | - N M Magomedova
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
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Vinciguerra A, Nonis A, Giordano Resti A, Ali MJ, Bussi M, Trimarchi M. Role of anaesthesia in endoscopic and external dacryocystorhinostomy: A meta-analysis of 3282 cases. Eur J Ophthalmol 2021; 32:66-74. [PMID: 34318721 DOI: 10.1177/11206721211035616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Distal acquired lacrimal obstruction is a common adulthood pathology whose primary treatment is represented by EXT-DCR and END-DCR. When considering their influencing factors, the role of the type of anaesthesia applied during these surgeries has a major role. The aim of this study is to systematically analyse the influence of general and local/regional anaesthesia on the final success rates of EXT-DCR and END-DCR. Primary EXT-DCR and END-DCR articles published later than 2000 with at least 50 single clinician procedures were selected. Exclusion criteria included acute dacryocystitis, tumours, studies focussing on revision surgeries, surgeries with adjunctive procedures, not clearly demarcated surgeons, mixed cohort study of acquired and congenital disorders. This systematic review was conducted in accordance with MOOSE guidelines; where feasible, a meta-analysis of the collected results was conducted. As a result, 11,445 articles were selected of which 2741 were examined after screening, and 16 included after full text review (0.6% of the initial papers). Among all papers included, the number of EXT-DCR was not enough to provide a solid analysis of the effect of anaesthesia; conversely, a significant difference of success rate was noted between local anaesthesia + sedation (85.1%, IC 77.8%-90.4%), and general anaesthesia (90.8%, IC 88.8%-92.4%) in END-DCR (p = 0.048). In conclusion, END-DCR performed with general anaesthesia should be considered as the solution of choice; however, local anaesthesia, eventually associated with a sedation, can be used as an alternative in selected cases. No meaningful conclusions could be drawn for EXT-DCR, due to the lack of data.
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Affiliation(s)
- Alessandro Vinciguerra
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Nonis
- CUSSB, University Centre for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Giordano Resti
- Division of Head and Neck Department, Ophthalmologic Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Mario Bussi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Trimarchi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Long-term results of a balloon-assisted endoscopic approach in failed dacryocystorhinostomies. Eur Arch Otorhinolaryngol 2021; 279:1929-1935. [PMID: 34251520 PMCID: PMC8273032 DOI: 10.1007/s00405-021-06975-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/28/2021] [Indexed: 11/27/2022]
Abstract
Purpose Endoscopic endonasal balloon-assisted dacryoplasty is a minimally invasive surgical approach that can be applied after failure of dacryocystorhinostomy with recurrence of distal acquired lacrimal obstruction. Methods At the Department of Otolaryngology, San Raffaele Hospital, Milan (Italy), from December 2016 to October 2020, 14 patients underwent trans-nasal balloon-assisted dacryoplasty after a failed dacryocystorhinostomy (both external and endoscopic endonasal). The routinary pre-operative work-up included multidisciplinary study of the lacrimal disease, which consisted in primary ophthalmological and otorhinolaryngological visits associated with nasal endoscopy, in which a radiological exam was added if needed. The surgical approach includes pneumatic enlargement of the stenotic rhinostomy, created during the primary dacryocystorhinostomy, using a high-pressure trans-nasal balloon catheter. Anatomical success was considered when the ostium was patent upon irrigation, while functional success was considered as resolution of epiphora or free lacrimal flow on functional test. Results Among 14 patients included and after a mean follow-up of 19.5 months (range 13–51 months), anatomic success was achieved in 100% of patients and functional success was achieved in the 85.7% (12/14). Operative time ranged from 9 to 28 min (mean 18 min) and no complications were reported. Conclusion Trans-nasal balloon-assisted dacryoplasty is a mini-invasive surgical approach to treat failed dacryocystorhinostomies with reliable and stable outcomes in the long term. The absence of post-surgical complications, high success rate and short operative time are the main features of this innovative procedure.
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Ethmoid Sinus Mucosal and Lacrimal Sac Flap Anastomosing in Patients With Failed Dacryocystorhinostomy. J Craniofac Surg 2021; 32:1071-1074. [PMID: 33055566 DOI: 10.1097/scs.0000000000007190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of this work is to demonstrate the outcomes of endonasal dacryocystorhinostomy (En-DCR) with anterior ethmoid sinus mucosal and posterior lacrimal sac flap anastomosing in patients with previous failed DCR. METHODS The clinical data of patients who suffered from recurrent epiphora after failed DCR between September 2014 and March 2018 were reviewed retrospectively. Among them, those who received the second En-DCR procedure were enrolled in this study. During the surgery, anterior ethmoidectomy was performed. Posterior lacrimal sac flap was apposed closely to the mucosal of anterior ethmoid sinus instead of nasal flap at end of the surgery. Patients were followed up more than 12 months were included, the success rate and complications were recorded. RESULTS Sixty-one eyes of 61 patients were enrolled in the study. The success rate of our modified En-DCR was 83.6% (51/61). Among 10 eyes with postoperative obstruction, 4 eyes caused by granuloma, 2 eyes caused by scar synechia, 2 eyes caused by membranous obstruction, and 2 eyes caused by common canalicular stenosis. No serious complications such as orbital fat prolapse, cerebrospinal fluid leak, sinusitis, or visual impairment were occurred in this study. CONCLUSION Endoscopic approach with anterior ethmoid sinus mucosal and posterior lacrimal sac flap anastomosing is a good choice for patients with recurrent epiphora after previous failed DCR.
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Vinciguerra A, Nonis A, Resti AG, Barbieri D, Bussi M, Trimarchi M. Influence of Surgical Techniques on Endoscopic Dacryocystorhinostomy: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2020; 165:14-22. [DOI: 10.1177/0194599820972677] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Endoscopic endonasal dacryocystorhinostomy (END-DCR) has increased as a valid alternative to the classic external approach to treat distal lacrimal obstruction. Different surgical varieties of the END-DCR approach have been proposed with no clear understanding of the best surgical technique. Data Source A comprehensive research was performed in PubMed, Embase, SCOPUS, and Cochrane databases with a final search on March 2020. Review Methods The aim of this search was to identify relevant END-DCR procedures performed with mechanical (Mecn-END-DCR) and powered (Pow-END-DCR) approaches to compare their functional success rate. In addition, the influence of mucosal flaps was evaluated. Articles were selected only if they were published later than 2000 and had at least 50 single-clinician surgical procedures performed. Excluded articles included acute infections, cancers, mixed cohort study, and revision cases. Results A total of 11,445 publications were identified and 2741 reviewed after screening; 15 articles were included after full-text review (0.6% of the initial articles reviewed). The mean success rate was 91.34% (95% CI, 87.1%-94.3%) for Pow-END-DCR and 89.5% (95% CI, 86.5%-91.9%) for Mecn-END-DCR with no significant difference between the surgical approaches ( P = .43). For mucosal flaps performed during END-DCR, the mean success rate was 89% (95% CI, 86%-91%) if mucosal flaps were used and 92% (95% CI, 88%-95%) if they were not used, with no statistical difference present ( P = .14). Conclusions Our analyses suggest that there are no differences in outcomes between mechanical and powered approaches in END-DCR and that mucosal flap preservation is not essential to achieve a superior END-DCR outcome.
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Affiliation(s)
- Alessandro Vinciguerra
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | - Alessandro Nonis
- CUSSB, University Centre for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milano, Italy
| | - Antonio Giordano Resti
- Division of Head and Neck department, Ophthalmologic Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Diego Barbieri
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Mario Bussi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | - Matteo Trimarchi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
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Yim M, Wormald P, Doucet M, Gill A, Kingdom T, Orlandi R, Crum A, Marx D, Alt J. Adjunctive techniques to dacryocystorhinostomy: an evidence‐based review with recommendations. Int Forum Allergy Rhinol 2020; 11:885-893. [DOI: 10.1002/alr.22699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/02/2020] [Accepted: 09/07/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Michael Yim
- Department of Otolaryngology–Head and Neck Surgery Louisiana State University Shreveport Shreveport LA
| | - Peter‐John Wormald
- Department of Surgery‐Otolaryngology University of Adelaide Adelaide Australia
| | - Manon Doucet
- Department of Otolaryngology–Head and Neck Surgery Louisiana State University Shreveport Shreveport LA
| | - Amarbir Gill
- Division of Otolaryngology – Head and Neck Surgery University of Utah Health Salt Lake City UT
| | - Todd Kingdom
- Department of Otolaryngology–Head and Neck Surgery University of Colorado Denver CO
| | - Richard Orlandi
- Division of Otolaryngology – Head and Neck Surgery University of Utah Health Salt Lake City UT
| | - Alison Crum
- Department of Ophthalmology and Visual Sciences John A Moran Eye Center Salt Lake City UT
| | - Douglas Marx
- Department of Ophthalmology and Visual Sciences John A Moran Eye Center Salt Lake City UT
| | - Jeremiah Alt
- Division of Otolaryngology – Head and Neck Surgery University of Utah Health Salt Lake City UT
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Indelicato P, Vinciguerra A, Giordano Resti A, Trimarchi M. A case of endonasal balloon-assisted dacryoplasty after failure of endonasal dacryocystorhinostomy. Clin Case Rep 2020; 8:1605-1609. [PMID: 32983459 PMCID: PMC7495747 DOI: 10.1002/ccr3.2956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/13/2020] [Accepted: 04/24/2020] [Indexed: 11/24/2022] Open
Abstract
Endonasal balloon-assisted dacryoplasty is a minimally invasive technique that uses a high-pressure balloon catheter introduced into the lacrimal pathway through the nasal fossa into the neorhinostomy to treat recurrent epiphora after primary dacryocystorhinostomy. This procedure can be considered to be a reliable technique in patients unfit for general anesthesia.
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Affiliation(s)
- Pietro Indelicato
- Division of Head and Neck DepartmentOtorhinolaryngology unitIRCCS San Raffaele Scientific InstituteMilanoItaly
- School of MedicineVita‐Salute San Raffaele UniversityMilanoItaly
| | - Alessandro Vinciguerra
- Division of Head and Neck DepartmentOtorhinolaryngology unitIRCCS San Raffaele Scientific InstituteMilanoItaly
- School of MedicineVita‐Salute San Raffaele UniversityMilanoItaly
| | - Antonio Giordano Resti
- Division of Head and Neck DepartmentOphthalmologic unitIRCCS San Raffaele Scientific InstituteMilanoItaly
| | - Matteo Trimarchi
- Division of Head and Neck DepartmentOtorhinolaryngology unitIRCCS San Raffaele Scientific InstituteMilanoItaly
- School of MedicineVita‐Salute San Raffaele UniversityMilanoItaly
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13
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Vinciguerra A, Nonis A, Resti AG, Bussi M, Trimarchi M. Impact of Post-Surgical Therapies on Endoscopic and External Dacryocystorhinostomy: Systematic Review and Meta-Analysis. Am J Rhinol Allergy 2020; 34:846-856. [DOI: 10.1177/1945892420945218] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Epiphora is a common ophthalmologic sign that is most commonly caused by distal acquired lacrimal obstruction. Recent data have demonstrated that external dacryocystorhinostomy (EXT-DCR) and endoscopic endonasal dacryocystorhinostomy (END-DCR) can be considered the treatments of choice. However, different post-surgical medical therapies are available and are currently used to improve surgical outcomes, although no direct comparison has been performed. Objective To analyse the influence of post-surgical medical treatments on END-DCR and EXT-DCR outcomes. Methods A structured search was conducted using the U.S. National Library of Medicine (PubMed), EMBASE, SCOPUS, and Cochrane databases with a final search performed in May 2020. The research identified papers published later than 2000 with at least 50 single clinician procedures performed in EXT-DCR and END-DCR. Articles that studied acute infections, revision cases, mixed cohort studies of acquired and congenital obstruction, and tumour were excluded. The influence of systemic antibiotic/steroids, local application of mitomycin C, nasal/ocular antibiotic, nasal/ocular steroids and nasal decongestants was analysed. Results In total, 11,445 papers were selected, 2,741 of which were reviewed after screening, and 18 included after full text review (0.6% of the initial articles reviewed) which involved 3,590 procedures. Considering the low number of publications on EXT-DCR, statistical analysis of post-surgical therapy was not feasible. In END-DCR, the analyses were performed only for nasal steroids (p = 0.58), oral antibiotics (p = 0.45) and nasal decongestant (p = 0.27), which demonstrated no meaningful influence. Given the variable association between adjunctive medical therapies, pharmacologic molecular heterogeneity and modality/concentration of application, these results should be considered critically. Additionally, no differences were seen for application of silicone stenting, whereas, no statistical analysis was performed for mitomycin C. Conclusions Given the high success rate of EXT-DCR and END-DCR and the heterogeneity of literature data, the effective influence of post-surgical medical therapy is difficult to identify. Future large prospective randomized studies could help in detecting the optimal adjunctive therapy for these surgeries.
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Affiliation(s)
- Alessandro Vinciguerra
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | - Alessandro Nonis
- CUSSB, University Centre for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milano, Italy
| | - Antonio Giordano Resti
- Division of Head and Neck Department, Ophthalmologic Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Mario Bussi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | - Matteo Trimarchi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
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14
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Indelicato P, Vinciguerra A, Giordano Resti A, Bussi M, Trimarchi M. Endoscopic endonasal balloon-dacryoplasty in failed dacryocystorhinostomy. Eur J Ophthalmol 2020; 31:2076-2081. [PMID: 32664743 DOI: 10.1177/1120672120942692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Endoscopic endonasal balloon-assisted dacryoplasty is a minimally-invasive surgical procedure that can be used in recurrent epiphora, a common pathology in both adulthood and childhood. STUDY DESIGN/SETTINGS We present a retrospective case series of eight patients who underwent trans-nasal balloon-assisted dacryoplasty after a failed external or endoscopic dacryocystorhinostomy, from March 2019 to January 2020, at the Department of Otolaryngology, San Raffaele Hospital, Milan, Italy. SUBJECTS AND METHODS All patients underwent routine preoperative work-up including fluorescein test (Jones test I-II), probing and irrigation of the lacrimal pathway and nasal endoscopy. Because of the recurrent nature of the pathology, pre-operatory computed tomography scan or dacryocystography was not performed. The surgical procedure was based on enlargement of the stenotic neorhinostomy created by primary dacryocystorhinostomy through the use of a high-pressure balloon catheter. Anatomical success was defined as a patent ostium on irrigation, whereas functional success was defined as free lacrimal flow on functional test and resolution of epiphora. RESULTS Anatomic and functional success was achieved in 100% of patients. Operative time ranged from 9 to 22 min (mean 16 min). No significant complications were reported. CONCLUSION Our results indicate that trans-nasal balloon-assisted dacryoplasty can be considered as a safe and reliable surgical approach after a failed primary dacryocystorhinostomy. The shorter surgical time and reduced post-operative complication rates are the main advantages of this procedure.
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Affiliation(s)
- Pietro Indelicato
- Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | - Alessandro Vinciguerra
- Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | - Antonio Giordano Resti
- Division of Head and Neck department, Ophthalmologic unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Mario Bussi
- Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | - Matteo Trimarchi
- Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
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15
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Cikrikci S, Erkan E, Agdas F. Association between septoplasty, Lund-Mackay score and Lund-Kennedy score with endoscopic dacryocystorhinostomy results. Orbit 2020; 40:274-280. [PMID: 32594817 DOI: 10.1080/01676830.2020.1782441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To compare endoscopic dacryocystorhinostomy (endo-DCR) + septoplasty with endo-DCR alone and determine the relationship between sinusitis and endo-DCR surgery results. METHODS Our study included 55 patients with nasolacrimal duct obstruction (NLDO) between June 2017 and June 2019. Patients were divided into two groups as endo-DCR alone and endo-DCR + septoplasty. Patients' symptoms were thoroughly evaluated and scored using the Lund-Mackay (LM) score and the Lund-Kennedy (LK) system. According to LK endoscopy scoring; those with a score of 0 were determined as group 1 (40 (58.8%) cases); and those with a score greater than 0 were determined as group 2 (28(41.2%) cases). According to LM CT scoring system, cases whose score was 0 were determined as group 1 (44(%66.2) cases); those greater than 0 were determined as group 2 (23(33.8%) cases). RESULTS A total of 68 endo-DCR surgeries, 42 unilateral and 13 bilateral, were performed. Forty one cases (60.3%) were managed with endo-DCR alone, and septoplasty surgery was performed in 27 (39.7%) cases in addition to endo-DCR due to septum deviation. There was no statistically significant difference in functional and anatomical success between the two groups in terms of surgery type (anatomical success p = .353, functional success p = .528); LK endoscopy scoring (anatomical success p = .956, functional success p = .925) and LM CT scoring system (anatomical success p = .202, functional success p = .172). CONCLUSION LK endoscopy and LM CT scores did not show any influence on functional and anatomic outcomes in endo-DCR cases.
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Affiliation(s)
- Sercan Cikrikci
- Department of Otolaryngology, Head and Neck Surgery, Yozgat City Hospital, Yozgat, Turkey
| | - Erol Erkan
- Department of Ophthalmology, Yozgat City Hospital, Yozgat, Turkey
| | - Fatih Agdas
- Department of Otolaryngology, Head and Neck Surgery, Yozgat City Hospital, Yozgat, Turkey
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16
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Vinciguerra A, Nonis A, Giordano Resti A, Bussi M, Trimarchi M. Best treatments available for distal acquired lacrimal obstruction: A systematic review and meta‐analysis. Clin Otolaryngol 2020; 45:545-557. [DOI: 10.1111/coa.13551] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/31/2020] [Accepted: 04/13/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Alessandro Vinciguerra
- Division of Head and Neck department Otorhinolaryngology unit IRCCS San Raffaele Scientific Institute Milano Italy
| | - Alessandro Nonis
- CUSSB University Centre for Statistics in the Biomedical Sciences San Raffaele Hospital Vita‐Salute University Milano Italy
| | - Antonio Giordano Resti
- Division of Head and Neck department Ophthalmologic unit IRCCS San Raffaele Scientific Institute Milano Italy
| | - Mario Bussi
- Division of Head and Neck department Otorhinolaryngology unit IRCCS San Raffaele Scientific Institute Milano Italy
| | - Matteo Trimarchi
- Division of Head and Neck department Otorhinolaryngology unit IRCCS San Raffaele Scientific Institute Milano Italy
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17
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Endoscopic dacryocystorhinostomy with and without mucosal flap-is there any difference? Eye (Lond) 2019; 34:1449-1453. [PMID: 31767961 PMCID: PMC7468247 DOI: 10.1038/s41433-019-0716-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/16/2019] [Accepted: 09/27/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The nasal mucosa is sacrificed in conventional endoscopic dacryocystorhinostomies (EDCRs). Some surgeons, however, modify the technique by elevating a mucosal flap prior to creating the osteotomy with the aim of preserving the mucosa. To our knowledge, no clear-cut benefit of a mucosal flap has been established. The aim of this study is to examine the differences in surgical techniques and success rates of EDCRs with and without mucosal flap preservation. METHODS We carried out a medical record review of all patients who underwent primary EDCR at the Goldschleger Eye Institute from October 2009 to October 2017. The following data were retrieved from the medical database and analyzed: patient demographics (age at diagnosis and gender), medical history, examination findings, surgical details, postoperative success, complications, and follow-up. RESULTS A total of 107 patients who underwent 117 EDCRs participated in the study. Fifty-one patients comprised the group without a mucosal flap and 56 patients comprised the group with mucosal flap preservation. The medical history, presenting complaints, and preoperative examination findings were similar for both groups. The surgical success rate was not significantly different between the groups (82.1% without flap vs. 86.8% with flap, P = 0.478, Chi-square). CONCLUSION The findings of this comparison of EDCRs with and without mucosal flap preservation in a large patient population revealed no differences in surgical success or complications rates between the two procedures and, therefore, no benefit for adding flap preservation to conventional EDCRs.
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18
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Trimarchi M, Giordano Resti A, Vinciguerra A, Danè G, Bussi M. Dacryocystorhinostomy: Evolution of endoscopic techniques after 498 cases. Eur J Ophthalmol 2019; 30:998-1003. [DOI: 10.1177/1120672119854582] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Endoscopic dacryocystorhinostomy is a well-known surgical practice used to treat nasolacrimal duct obstruction and widely considered as a valid alternative to external approaches. Purpose: We present a retrospective case series of 498 endoscopic dacryocystorhinostomies on 401 patients, from July 2004 to May 2018, at the Department of Otolaryngology, San Raffaele Hospital, Milan, Italy. Methods: Of the 498 procedures, 426 were unilateral and 72 were bilateral dacryocystorhinostomy. All patients underwent routine preoperative workup including fluorescein test (Jones test 1–2), probing and irrigation of the lacrimal way, nasal endoscopy, and maxilla-facial computed tomography scan. Surgical technique was based on nasal endoscopic dacryocystorhinostomy followed by positioning of a Catalano’s silicone stent, which was left in place for about 3 months. Anatomical success was defined as a patent ostium on irrigation, whereas functional success was defined as free lacrimal flow on functional test and resolution of epiphora. Results: Anatomic success was achieved in 91.54% cases in primary dacryocystorhinostomy and in 89.36% after revision, whereas functional success was obtained in 90.4% in primary and 85.1% in secondary dacryocystorhinostomies. After a second revision of endoscopic dacryocystorhinostomy, anatomical success was achieved in 90.1% and functional success in 88.7% of procedures. Conclusion: Our results confirm that endoscopic dacryocystorhinostomy can be considered as a valid surgical approach to primary nasolacrimal duct obstruction and revision cases. The key aspects in achieving functional and anatomical results are meticulous surgical procedure and precise follow-up.
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Affiliation(s)
- Matteo Trimarchi
- Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Antonio Giordano Resti
- Division of Ophthalmology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Alessandro Vinciguerra
- Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Giulia Danè
- Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Mario Bussi
- Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
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19
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At'kova EL, Zhukov OV, Krakhovetskiy NN, Yartsev VD, Reznikova LV. [Intraoperative prevention of dacryocystitis relapse]. Vestn Oftalmol 2018; 134:270-275. [PMID: 30499528 DOI: 10.17116/oftalma2018134051270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The article reviews the literature devoted to modern intraoperative methods of preventing cicatricial process at the site of dacryostoma after endonasal endoscopic dacryocystorhinostomy. Despite the constant improvement of the surgery technique, complications in the postoperative period still occur. They include the formation of granulation tissue at the sites of dacryostoma, synechiae in the nasal cavity, or narrowing of the dacryostoma, which ultimately leads to a relapse of the disease. The main prevention methods are construction of flaps from the medial wall of the lacrimal sac, from mucosa of the nasal cavity, and intubation of the dacryostoma with the lacrimal implant. They are used separately and in various combinations.
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Affiliation(s)
- E L At'kova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - O V Zhukov
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - N N Krakhovetskiy
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - V D Yartsev
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - L V Reznikova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021; I.M. Sechenov First Moscow State Medical University, Chair of Ophthalmology, 8-2 Malaya Trubetskaya St., Moscow, Russian Federation, 119991
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20
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Mishra AK, Nilakantan A, Mishra S, Mallick A. Comparison of balloon dacryocystorhinostomy with conventional endonasal endoscopic dacryocystorhinostomy for relief of acquired distal nasolacrimal drainage obstruction and its impact on quality of life: A prospective, randomized, controlled study. Med J Armed Forces India 2017; 74:255-263. [PMID: 30093769 DOI: 10.1016/j.mjafi.2017.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 08/30/2017] [Indexed: 10/18/2022] Open
Abstract
Background We compared balloon dacryocystorhinostomy with conventional endoscopic dacryocystorhinostomy for the management of acquired distal nasolacrimal obstruction and the quality of life post procedure. Methods 98 patients, aged 10-73 years, were recruited and randomized into 2 groups of 49 each who underwent conventional endoscopic dacryocystorhinostomy (group 1) and 9 mm balloon assisted endoscopic dacryocystorhinostomy (group 2). Follow-up sessions were conducted at 3, 6 and 12 months post-op. Results Group 2 showed significantly shorter mean operative time (25.10 min versus 29.82; p < 0.001), lesser pain in the post-op evening (mean 2.12 versus 2.9 on NRS-11 pain scale; p < 0.001) as well as on first post-op day (mean 1.08 versus 1.73; p < 0.001). Success was achieved in 89.79% in group 1 and 93.87% in group 2 at 3 months (p = 0.46) which declined due to recurrences to 85.71% and 87.75% respectively at 12 months (p = 0.76). Complications occurred in 14 cases in group 1 and in 10 cases in group 2 (p = 0.34). All were minor. Mean GBI scores (for quality of life assessment) at 12 months follow-up were 27.20 and 28.38 respectively (p = 0.08). Conclusion The efficacy, safety and quality of life of balloon dacryocystorhinostomy and conventional endoscopic dacryocystorhinostomy were comparable. In addition, balloon dacryocystorhinostomy had significantly shorter operative time and lesser post-op pain.
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Affiliation(s)
| | - Ajith Nilakantan
- Professor & Head, Dept of ENT - HNS, Armed Forces Medical College, Pune 411040, India
| | - Sanjay Mishra
- Senior Adviser (Ophthalmology), Command Hospital (Central Command), Lucknow, India
| | - Ajay Mallick
- Classified Specialist (ENT-HNS), Base Hospital, Delhi Cantt 110010, India
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21
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Double Posterior Based Flap Technique in Primary Endoscopic Dacryocystorhinostomy With and Without Using Powered Instrument. Indian J Otolaryngol Head Neck Surg 2017; 69:474-479. [PMID: 29238676 DOI: 10.1007/s12070-017-1227-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 10/06/2017] [Indexed: 10/18/2022] Open
Abstract
To demonstrate the surgical technique and outcomes of double posterior based flap technique in primary endoscopic dacryocystorhinostomy (DCR) with and without use of powered instrument. 28 patients of nasolacrimal duct obstruction were included in the study from September 2012 to February 2015. All underwent endoscopic dacryocystorhinostomy with double posterior based nasal and lacrimal flap technique. In patients of group A (14 patients), bone removal was done with the help of Smith-Kerrison punch forceps and in patients of group B (14 patients), powered drill has been used for the same. Patients were visited the endoscopic clinic at 1, 3, 6 months and 1 year after the surgery for post operative evaluation. Of 28 patients, 26(92.85%) were found free of symptoms at the end of 1, 3 and at 6 months. One from each group had recurrence of symptoms. At the end of 12 months of 25 patients, 3(12%) patients were found to have recurrence of symptoms of which 1(8.33%) patients was from group A and 2(15.38%) were from group B and failures were because of granulation tissue and stomal stenosis. Patients assisted with powered drill had more postoperative complications compared to cold instrument. Double posterior based flap technique in primary endoscopic DCR without the assistance of powered drill could be an effective surgical option for the patients of chronic nasolacrimal duct obstruction enabling early epithelisation by preventing peristomal granulation tissue resulting in encouraging surgical outcome with least postoperative complication.
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22
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Wu S, Xu T, Fan B, Xiao D. Endoscopic dacryocystorhinostomy with an otologic T-type ventilation tube in repeated revision cases. BMC Ophthalmol 2017; 17:138. [PMID: 28784098 PMCID: PMC5547563 DOI: 10.1186/s12886-017-0539-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 08/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To compare the frequency of appearance of complications, anatomical success and functional success after conventional endoscopic dacryocystorhinostomies (EN-DCRs) or EN-DCR with otologic T-Type ventilation tube combined with silicone tube intubation in repeated revision cases. METHODS Twenty-two patients who had epiphora and recurrent dacryocystitis after at least a previous failed revision DCR as well as 22 patients receiving conventional EN-DCR only were enrolled in the study between January 2008 and December 2011. Operations were performed by using an otologic T-tube combined with silicone tube intubation. Oral antibiotics, nasal steroids, oral antihistamines, and antibiotic eyedrops were given to all cases. The ventilation tubes were removed 6 to 20 weeks after surgery. RESULTS Of 22 cases, all cases achieved anatomical success, 19 cases were symptom free, and 3 cases had decreased continuation in complications with a functional success rate of 81.8%. The overall success rates were significantly higher than those in patients undertaking conventional EN-DCR only (P < 0.01). CONCLUSION The revision endoscopic DCR has a high rate of failure. The usage of a T-type ventilation tube can significantly improve the success rate of surgery. TRIAL REGISTRATION NUMBER ChiCTR-INR-17012160, retrospectively registered on July 27th, 2017.
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Affiliation(s)
- Sihai Wu
- Department of Otorhinolarynogology, The Second People's Hospital of Wuxi, Nanjing Medical University, NO. 68, Zhongshan Road Wuxi, Nanjing, Jiangsu, 214002, China
| | - Ting Xu
- Department of Otorhinolarynogology, The Second People's Hospital of Wuxi, Nanjing Medical University, NO. 68, Zhongshan Road Wuxi, Nanjing, Jiangsu, 214002, China
| | - Bin Fan
- Department of Otorhinolarynogology, The Second People's Hospital of Wuxi, Nanjing Medical University, NO. 68, Zhongshan Road Wuxi, Nanjing, Jiangsu, 214002, China
| | - Dajiang Xiao
- Department of Otorhinolarynogology, The Second People's Hospital of Wuxi, Nanjing Medical University, NO. 68, Zhongshan Road Wuxi, Nanjing, Jiangsu, 214002, China.
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23
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Peng W, Tan B, Wang Y, Wang H, Wang Z, Liang X. A Modified Preserved Nasal and Lacrimal Flap Technique in Endoscopic Dacryocystorhinostomy. Sci Rep 2017; 7:6809. [PMID: 28754905 PMCID: PMC5533767 DOI: 10.1038/s41598-017-07364-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 06/26/2017] [Indexed: 12/04/2022] Open
Abstract
Here we describe a modified preserved nasal and lacrimal mucosal flap technique in endonasal endoscopic dacryocystorhinostomy (EES-DCR) for patients with epiphora secondary to primary acquired nasolacrimal duct obstruction (PANDO) and evaluate its outcomes. Twenty-five patients with PANDO were retrospectively reviewed. Modified preserved nasal and lacrimal mucosal flap technique in EES-DCR was applied in all 27 eyes of 25 patients. The patients were evaluated with objective (anatomical patency) and subjective (symptomatic cure) success rates within the duration of follow-up. In the present study, all of the patients’ surgical procedures were successful. There were 2 cases of flap dislocation from the rhinostomy site 1 week post-operation. After a mean follow-up of 4.9 ± 1.8 months, the success rate of anatomical patency was 100% (27/27) and the success rate of symptomatic cure was 92.6% (25/27). No significant complications occurred intraoperatively. We concluded that the modified preserved nasal and lacrimal mucosal flap technique in EES-DCR for treating PANDO is simple and safe, can effectively cover the bare bone around the opened sac, and provide a similar or even better clinical outcome compared with other routine treatment techniques used for this condition.
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Affiliation(s)
- Wenyan Peng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, P.R. China
| | - Bowei Tan
- Brookdale University Hospital and Medical Center, Brooklyn, NY, 11212, USA
| | - Yandong Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, P.R. China
| | - Haiying Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, P.R. China
| | - Zhonghao Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, P.R. China.
| | - Xuanwei Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, P.R. China.
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Shin HJ, Woo KI, Kim YD. Factors associated with rhinostomy shape after endoscopic dacryocystorhinostomy. Clin Otolaryngol 2016; 42:550-556. [PMID: 27727517 DOI: 10.1111/coa.12767] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the factors associated with rhinostomy shape after endoscopic dacryocystorhinostomy (DCR) in patients with primary acquired nasolacrimal duct obstruction. DESIGN Retrospective comparative study. SETTING University hospital. PARTICIPANTS One hundred and two cases in 70 patients were included in the study. MAIN OUTCOME MEASURE All cases were classified into three groups according to the healed appearance of the rhinostomy: flat, ladle and ice scoop type. The flat shape was characterised by an opening with a flat surrounding and no clear border between the lacrimal sac and the nasal mucosa. The ladle shape had a depressed base without markings of a lacrimal sac. The ice scoop shape had a depressed base with a clear border between the lacrimal sac and the nasal mucosa. Anatomic success was defined as patency with syringing and endoscopic evidence of ostial patency. Functional success was defined as visualisation of fluorescein dye at the ostium and relief from epiphora. Clinical information and intra- and postoperative endoscopic video findings were compared between the three groups. RESULTS Of the 102 cases, 19 flat, 37 ladle and 46 ice scoop type rhinostomies were observed during the follow-up examinations. Among the variables studied, patient demographics and rhinostomy size and location did not differ between the three groups. However, intraoperative lacrimal sac findings (sac size, wall thickness and mobility), postoperative ostial shrinkage and rhinostomy movement were associated with postoperative rhinostomy shape (all P < 0.05). With regard to surgical outcomes, there were no differences in anatomical patency between the three groups. However, the flat group had a worse functional success rate (73.7%) than the ladle (91.9%) and ice scoop (97.8%) groups (P = 0.008). A higher degree of ostial shrinkage and poor rhinostomy movement was observed with the flat shape appearance, which had a small, thick and poorly mobile lacrimal sac. CONCLUSIONS Lacrimal sac characteristics play a prominent role in determining rhinostomy shape after endoscopic DCR. The rhinostomy shape, along with the degree of ostial shrinkage and rhinostomy movement, is predictive of functional success after endoscopic DCR.
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Affiliation(s)
- H J Shin
- Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - K I Woo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Y-D Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Green R, Gohil R, Ross P. Mucosal and lacrimal flaps for endonasal dacryocystorhinostomy: a systematic review. Clin Otolaryngol 2016; 42:514-520. [PMID: 27662629 DOI: 10.1111/coa.12754] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Historically dacryocystorhinostomy (DCR) has been performed externally with very good outcomes. Current literature shows comparable success rates between endonasal and external approaches. A common reason for the failure of a DCR is the reclosure of the nasolacrimal stoma by granulation tissue and synechiae. OBJECTIVE OF REVIEW A systematic review and critical evaluation of the evidence relating to the preservation of nasal mucosal flaps in DCR surgery. TYPE OF REVIEW AND EVALUATION METHOD A systematic review using the consort guidance for review of randomised control trials. SEARCH STRATEGY A search of the following evidence-based medicine databases was performed: Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness, Cochrane Central Register of Controlled Trials, Ovid, Medline, EMBASE and PubMed. The search was limited to English language articles, and the following key words were used: Endonasal, Endoscopic, Dacryocystorhinostomy, DCR, Mucosal Flaps, between years 1970 and 2015. RESULTS The best available evidence was level 1B, comprising two randomised control trials and three comparative studies included in the review. The main outcome measures used were lacrimal irrigation and absence of epiphora. Two of the studies demonstrated a statistically significant benefit of mucosal sparing either with nasal mucosal flaps or with lacrimal flaps. More debridement was needed, and granulation tissue was also seen in the groups without mucosal preservation. There was no difference in surgical complications between a mucosal and non-mucosal-sparing technique. CONCLUSIONS The overall quality of current evidence is poor, and there does however appear to be a trend towards improved outcomes and reduced granulation in groups where nasal mucosal and lacrimal flaps were preserved, but this is not clear-cut. There was no evidence of increased complication rates with mucosal-sparing techniques. We recommend that until further good quality research is available we should be performing a mucosal-sparing technique when performing DCR routinely.
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Affiliation(s)
- R Green
- ENT Department Ninewells Hospital, Dundee, UK
| | - R Gohil
- ENT Department Ninewells Hospital, Dundee, UK
| | - P Ross
- ENT Department Ninewells Hospital, Dundee, UK
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Ali MJ, Psaltis AJ, Wormald PJ. Long-term outcomes in revision powered endoscopic dacryocystorhinostomy. Int Forum Allergy Rhinol 2014; 4:1016-9. [DOI: 10.1002/alr.21398] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 06/06/2014] [Accepted: 07/08/2014] [Indexed: 11/06/2022]
Affiliation(s)
| | - Alkis James Psaltis
- Department of Surgery-Otolaryngology; Head and Neck Surgery, University of Adelaide; Adelaide Australia
| | - Peter John Wormald
- Department of Surgery-Otolaryngology; Head and Neck Surgery, University of Adelaide; Adelaide Australia
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Lombardi D, Mattavelli D, Accorona R, Turano R, Semeraro F, Bozzola A, Nicolai P. Acute Dacryocystitis with Empyema of the Lacrimal Sac: Is Immediate Endoscopic Dacryocystorhinostomy Justified? Otolaryngol Head Neck Surg 2014; 150:1071-7. [PMID: 24647640 DOI: 10.1177/0194599814527236] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 02/18/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the efficacy of endoscopic dacryocystorhinostomy (Endo-DCR) in the treatment of acute dacryocystitis with lacrimal sac empyema (ADLSE). DESIGN Case series with chart review. SETTING Academic tertiary center. PATIENTS The study included 26 consecutive patients who underwent Endo-DCR for ADLSE between August 2005 and December 2013. MAIN OUTCOME MEASURES The success of the procedure was defined as complete complaint relief and DCR patency. Data on the time from referral to surgery, postoperative complications, and revision surgery are also reported. RESULTS The present patient series included 4 males (15.4%) and 22 females (84.6%) (mean age, 66 years). The mean time between referral and surgery was 0.88 days and the mean follow-up time was 29 months. All patients showed immediate relief from symptoms, with no ADLSE recurrences. Complete success was achieved in 25 (96.2%) cases; the only failure was in a patient who had previously undergone radioiodine treatment. In this case, revision Endo-DCR was not successful. The only perioperative complication (3.8%) was epistaxis in a patient who required revision surgery under general anesthesia. The definitive success rate was 96.2% after primary and revision surgery. CONCLUSIONS Endo-DCR enables rapid resolution of ADLSE with a very high success rate. Immediate surgery may reduce the risk of skin fistulization and/or orbital complications. DCR shrinkage and lacrimal obstruction are unlikely with Endo-DCR since the procedure is performed on an enlarged sac. The main advantage of Endo-DCR, compared with external DCR, is the absence of a skin incision in an inflamed and infected field.
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Affiliation(s)
- Davide Lombardi
- Department of Otorhinolaryngology, University of Brescia, Italy
| | | | - Remo Accorona
- Department of Otorhinolaryngology, University of Brescia, Italy
| | | | | | - Anna Bozzola
- Department of Otorhinolaryngology, University of Brescia, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology, University of Brescia, Italy
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Nasolacrimal duct obstruction secondary to dental impaction. Eur J Ophthalmol 2013; 24:611-3. [PMID: 24366764 DOI: 10.5301/ejo.5000410] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe a patient with nasolacrimal duct obstruction (NLDO) caused by dental impaction. METHODS This is an interventional case report of an 18-year-old man presenting epiphora of the right eye. Previous surgical management was unsuccessful. Computed tomography (CT) of the orbits and sinuses was performed. Dacryocystorhinostomy (DCR) on the right lacrimal sac resulted in complete remission of symptoms. The DCR surgical outcome at last follow-up was recorded. RESULTS The CT imaging showed ankylosis of deciduous canines and impaction of persistent canines. The root of the right impacted dental element was involved with the nasolacrimal duct, leading to NLDO. Endoscopic DCR resulted in complete remission of symptoms. The patient was symptom-free at last follow-up. CONCLUSIONS Our case adds NLDO to the long list of complications arising from dental impactions, highlighting the importance of correct early management of the latter condition. This case also shows that dental impaction can be included among the secondary mechanical causes of NLDO.
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Mak ST, Io IYF, Wong ACM. Prognostic factors for outcome of endoscopic dacryocystorhinostomy in patients with primary acquired nasolacrimal duct obstruction. Graefes Arch Clin Exp Ophthalmol 2012; 251:1361-7. [DOI: 10.1007/s00417-012-2228-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 11/23/2012] [Accepted: 11/26/2012] [Indexed: 10/27/2022] Open
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Ji QS, Zhong JX, Tu YH, Wu WC. New mucosal flap modification for endonasal endoscopic dacryocystorhinostomy in Asians. Int J Ophthalmol 2012; 5:704-7. [PMID: 23275904 DOI: 10.3980/j.issn.2222-3959.2012.06.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 11/09/2012] [Indexed: 11/02/2022] Open
Abstract
AIM To describe a simple modification of fashioning the mucosal flap for endonasal endoscopic dacryocystorhinostomy (EES-DCR) in Asians and investigate its efficacy. METHODS A total of 120 patients with unilateral primary chronic dacryocystitis (PCD) were randomized into two groups: the new shaped nasal mucosal flap group (group A) and the removed nasal mucosal flap group (group B). All patients underwent standard EES-DCR. Patients in group A were performed a new shaped nasal mucosal flap covering the bared bone around the opened sac and those in group B was removed the nasal mucosal flap uncovering the bared bone. Patients were followed up for one year. The occurrence of granulation tissue, the proliferation of scar tissue and success rate of EES-DCR was compared. RESULTS In the present study, complete postoperative data were acquired from 54 patients in group A and from 57 patients in group B. During process of review, the occurrence of granulation tissue was at the ostium margins account for 15% (8/54) in group A and 39% (22/57) in group B (P<0.05). At the one-year review, scar tissue was present in 5 patients in group A compared with 18 in group B (P<0.05). The success rate of EES-DCR was 98% (53/54) in group A and 84% (48/57) in group B (P<0.05). CONCLUSION The simple modification of fashioning nasal mucosal flap can effectively cover the bared bone around the opened sac and reduce formation of granulation tissue, lessen the risk of scar tissue formation and closure of ostium, thus improve the success rate of EES-DCR in Asians.
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Affiliation(s)
- Qing-Shan Ji
- Department of Ophthalmology, the First Affiliated Hospital of Jinan University, Guangzhou 510632, Guangdong Province, China
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Çukurova I, Caner Mercan G, Çetinkaya E, Gümüsssoy M, Söken H. Endoscopic dacryocystorhinostomy: outcomes using mucosal flap preserving technique. Eur Arch Otorhinolaryngol 2012. [PMID: 23179941 DOI: 10.1007/s00405-012-2285-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Currently, transnasal approaches are preferred widely for treating chronic dacryocystitis. Restenosis which count for the most common causes of failure in endoscopic dacryocystorhinostomy (EDCR) reduces the success rate. We intended to make a large fistula, potentially minimizing granulation tissue, and synechiae by means of creating a large bony ostium and preserving mucosal flaps and intubation with silicone tube (STI). In this study, long-term follow-up results of EDCR with mucosa preservation were discussed. 126 patients underwent endonasal DCRs from January 2004 to March 2009. A large ostium was created preserving mucosa; nasal and lacrimal flaps were approximated and the new ostium was stented with silicone tube. Surgical success rate was 93 % with STI and with preservation of nasal and lacrimal flaps. In conclusion, EDCR is an easy surgical procedure with low complication rates. Intranasal pathologies can also be corrected in the meantime. Success depends on creating a large bony ostium and preventing restenosis. EDCR preserving nasal and lacrimal flaps with STI is recommended as an alternative procedure in chronic dacryocystitis with high success rates.
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Affiliation(s)
- Ibrahim Çukurova
- Department of Otolaryngology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
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Khalifa MA, Ragab SM, Saafan ME, El-Guindy AS. Endoscopic Dacryocystorhinostomy with Double Posteriorly Based Nasal and Lacrimal Flaps. Otolaryngol Head Neck Surg 2012; 147:782-7. [DOI: 10.1177/0194599812447759] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives To conduct the first prospective randomized controlled trial assessing and comparing the safety and efficacy of endoscopic dacryocystorhinostomy (DCR) with double posteriorly based nasal and lacrimal flaps to conventional endoscopic DCR in adult patients with acquired complete nasolacrimal obstruction. Study Design A prospective randomized controlled study. Setting General hospital. Subjects and Methods Seventy-four adult patients with a total of 80 procedures were recruited to undergo endoscopic DCR. They were prospectively equally randomized into 2 groups: endoscopic DCR with flaps (group I) and conventional endoscopic DCR (group II). Regular follow-up settings were done to document the patient’s subjective improvement, judge ostium patency on irrigation, and record any complications. Results Endoscopic DCR with flaps had a higher (92.1%) but nonsignificant difference in success rate when compared with conventional endoscopic DCR (87.4%). There was no significant difference between the 2 techniques in operative time, adverse events, and tolerability of the technique to be done under local anesthesia with minimal sedation. Group I demonstrated a significantly lower number of debridement sessions than did group II. Conclusion Endoscopic DCR with double posteriorly based nasal and lacrimal flaps provides a viable alternative to conventional endoscopic DCR in managing acquired nasolacrimal duct obstructions in adults. It has a comparable success rate, operative time, and safety profile, with a suggestion of a better healing profile in terms of mucosal recovery, wound healing, and less need for debridement sessions.
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Affiliation(s)
- Mohammed A. Khalifa
- Department of Otolaryngology and Head & Neck Surgery, Tanta University Hospitals, Tanta, Egypt
| | - Sameh M. Ragab
- Department of Otolaryngology and Head & Neck Surgery, Tanta University Hospitals, Tanta, Egypt
| | - Magdy E. Saafan
- Department of Otolaryngology and Head & Neck Surgery, Tanta University Hospitals, Tanta, Egypt
| | - Ahmed S. El-Guindy
- Department of Otolaryngology and Head & Neck Surgery, Tanta University Hospitals, Tanta, Egypt
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2011; 19:58-65. [PMID: 21233627 DOI: 10.1097/moo.0b013e32834344aa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wu W, Cannon PS, Yan W, Tu Y, Selva D, Qu J. Effects of Merogel coverage on wound healing and ostial patency in endonasal endoscopic dacryocystorhinostomy for primary chronic dacryocystitis. Eye (Lond) 2011; 25:746-53. [PMID: 21394118 DOI: 10.1038/eye.2011.44] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To investigate the effects of Merogel coverage on ostial patency in endonasal endoscopic dacryocystorhinostomy (EES-DCR) for primary chronic dacryocystitis (PCD). METHODS In all, 260 patients with unilateral PCD were randomized into two groups: the Merogel group and the control group. All patients underwent EES-DCR. The Merogel group received Merogel covering the wound 1-2 mm around the ostium and the control group received no treatment. Patients were followed up for 9 months. The mucosal epithelialization of the wound, the proliferation of fibrosis tissue, and the success rate of ostial patency were compared. RESULTS Our study included 112 patients in the Merogel group and 115 patients in the control group. At the 2-week review, intact mucosal epithelium lined the ostia in 96 Merogel patients compared with 80 control patients (ITT analysis: χ(2)=4.502, P=0.034). At the 9-month review, scars were present in 18 patients in the Merogel group compared with 39 patients in the control group (ITT analysis: χ(2)=9.909, P=0.002, ITT analysis). No differences were observed in the granulation formation between the two groups. The success rate of ostial patency reached 94.6% (106/112) in the Merogel group compared with 80% (92/115) in the control group (ITT analysis: χ(2)=4.151, P=0.042). CONCLUSION Merogel coverage may enhance the success rate of EES-DCR for PCD by promoting mucosal epithelial healing and preventing excessive scarring.
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Affiliation(s)
- W Wu
- Department of Orbital and Oculoplasty Surgery, Eye Hospital of Wenzhou Medical College, Wenzhou, Zhejiang, PR China.
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Kodama S, Hirano T, Suzuki M. Endoscopic Dacryocystorhinostomy with Mucosal Flap. ACTA ACUST UNITED AC 2011; 114:820-3. [DOI: 10.3950/jibiinkoka.114.820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Jang HD, Kim SS. Results of Endonasal Dacryocystorhinostomy with Lacrimal Sac Flap and Silastic Sheet. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.12.1391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hyun Duk Jang
- Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea
| | - Sang Soo Kim
- Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea
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Current World Literature. Curr Opin Ophthalmol 2010. [DOI: 10.1097/icu.0b013e32833e6970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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