Ostium Characteristics and Its Relevance in Successful Outcome Following Endoscopic Dacryocystorhinostomy

Anatomical requirements for dacryocystorhinostomy ostium patency

PURPOSE

To identify anatomical factors affecting the outcome of dcryocystorhinostomy (DCR).

METHODS

The study included the results of dacryocystography in 73 patients after DCR: 37 cases of failed DCR and 36 cases of successful DCR. Biometric characteristics of the formed ostium were evaluated: the horizontal size of the bony "window" and the soft tissue part of the ostium, the vertical size of the bony "window" and soft tissue ostium, the height of the fragment of the remaining bone above and below the line of the common canaliculus, and the height of the "pocket" formed below the lower edge of the ostium. Statistical analysis was performed using parametric and non-parametric statistical methods. Differences were considered significant at p ≤ 0.05.

RESULTS

Intergroup differences were identified in the values of the maximum horizontal size of the bony "window" (p = 0.015), the maximum horizontal size of the soft tissue "window" (p < 0.001), the maximum vertical size of the soft tissue "window" (p < 0.001), and the height of the fragment of the remaining bone below the level of the common canaliculus to the edge of the formed ostium (p = 0.004).

CONCLUSION

The stage of forming the bony "window" influences the success of DCR. Not only the position of the "window" is important, but also the geometric properties of the formed ostium.

Prospective, randomised clinical trial on the necessity of using a silicone intubarium in the context of endonasal-endoscopic dacryocystorhinostomy (EN-DCR) in patients with postsaccal lacrimal duct stenosis

BACKGROUND

This prospective clinical study evaluates the effect of a silicone stent tube (SST) on the success rate of endonasal-endoscopic dacryocystorhinostomy (EN-DCR) to treat primary acquired nasolacrimal duct obstruction.

METHODS

Patients were randomly assigned to receive EN-DCR with or without SST intubation over a period of 3 months. The surgery was performed using standardized techniques. Patients were assessed at three different timepoints: one day, 12 weeks and 24 weeks after the surgery. The results were compared in order to evaluate statistical differences. Surgical success was determined by means of positive irrigation procedures, as well as by the improvement of symptoms and a high level of patient satisfaction.

RESULTS

A total of 56 randomized cases completed 24 weeks of follow up. 1 Patient dropped out due to malignant genesis of the nasolacrimal duct obstruction. After 24 weeks of follow up no statistically significant differences in levels of epiphora (p > .10) or patency (p > .16) were revealed. Comparisons regarding changes in time did not show levels of significance (p > .28).

CONCLUSIONS

This study could not confirm a statistically significant benefit or disadvantage for SST Insertion in EN-DCR.

Prognosis of concurrent endoscopic dacryocystorhinostomy and nasal septoplasty for chronic dacryocystitis with moderate nasal septum deviation

CONTEXT

The prognosis of combined septoplasty and endoscopic dacryocystorhinostomy (En-DCR) for moderate nasal septum deviation (NSD) has not yet been fully investigated.

PURPOSE

To evaluate whether septoplasty improves the prognosis of En-DCR for moderate NSD.

SETTINGS AND DESIGN

A retrospective cohort study in a real-world clinical setting.

METHODS

The postoperative FICI DCR ostium grading scores and functional and anatomical information at 1, 2, 3, and 6 months were determined for consecutive patients with chronic dacryocystitis (CD) and moderate NSD who underwent En-DCR.

STATISTICAL ANALYSIS USED

Univariate and generalized estimating equation multivariate analyses were used to compare the outcomes of the septoplasty and non-septoplasty groups.

RESULTS

En-DCR and septoplasty were concurrently performed for 32 (20.1%, 32/158) cases. The total FICI DCR ostial scores for the septoplasty and non-septoplasty groups were highest at the first (4.97 ± 0.177 vs. 4.97 ± 0.176, P > 0.05) and lowest at the sixth (4.41 ± 1.341 vs. 4.50 ± 1.355, P > 0.05) postoperative months. At the end of follow-up, the two groups showed comparable proportions of patients requiring definitive intervention for the ostium (6.3% vs. 7.1%, P > 0.05), comparabe functional success rates (87.5% vs. 90.5%, P > 0.05) and anatomical success rates (93.8% vs. 92.9%, P > 0.05). Only the non-septoplasty group experienced nasal mucosal adhesions (3.2%, 4/126).

CONCLUSIONS

In patients with CD and moderate NSD, nasal septoplasty did not impact En-DCR prognosis, but reduced the complications. Skilled surgeons should reconsider septoplasty in the absence of otolaryngological indications.

The FICI grading for a dacryocystorhinostomy ostium

PURPOSE

The objective of this study is to propose a simple grading to assess the health of a dacryocystorhinostomy (DCR) ostium.

METHODS

Prospective case series of 237 Ostia evaluated following dacryocystorhinostomy were included in the study. All the ostia were assessed for 10 parameters in detail using the earlier published DCR ostium scoring (DOS scoring). Each of the 10 parameters were scored individually, and final DOS scores were obtained. The anatomical and functional outcomes of each of the surgery were noted. The most significant parameters that influenced the success were determined using the binary recursive partitioning in a conditional inference framework. Data management and statistical tests were performed using the statistical "Software R" and the library "partykit" toolkits.

RESULTS

The most significant DCR ostium parameters that influenced the outcomes were anatomical and functional fluorescein dye transit (p < 0.001), dynamicity of internal common opening (ICO) on the blink (p < 0.001), end-on threats to ICO from granuloma, membrane or a synechia, and cicatricial closure of the Ostia. Each of these significant factors (FICI - Fluorescein endoscopy dye test, ICO dynamicity, Cicatricial ostium closure and ICO threats) were assigned simple scoring and the final scores were graded from 0 (poor DCR ostium) to +5 (excellent DCR ostium). FICI grading can guide the physician on the health status of the DCR ostium and the possible need for intervention.

CONCLUSION

FICI DCR ostium grading is a simple, easy to perform, and physician-friendly system. More studies with larger sample size would help in further validating the FICI grading.