Evaluation of Endoscopic Dacrocystorhinostomy Using Microdrill with Creation of Mucosal Flaps
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- Category: Vol. 77, June 2009
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Evaluation of Endoscopic Dacrocystorhinostomy Using Microdrill with Creation of Mucosal Flaps,AMR ABD EL-FATTAH, OSAMA AL-NAHRAWY, EHAB GHONIUM, AHMAD ANWAR, HESHAM ALI and TAREK EL-NAHRIRY
Abstract
Purpose: To describe and assess the efficacy of endoscopic dacrocystorhinostomy using microdrill. This is a new technique that involves creation of a large rhinostomy and creation of mucosal flaps. The study involved a prospective nonrandom-ized interventional case series with short post-operative follow-up.
Methods: A prospective series of 30 consecutive endonasal DCRs. Patients included in the study had nasolacrimal duct obstruction and had not had previous lacrimal surgery. The technique involved formation of a large bony ostium and apposition of nasal mucosal and lacrimal sac flaps. Surgery was performed by two surgeons (Ophthalmologist / otorhino-laryngologist). Follow-up assessment included nasoendoscopy as well as symptom evaluation. Success was defined as anatomical patency with fluorescein flow on nasoendoscopy and patency to lacrimal syringing. The average follow-up time was 6 months (range 2-9 months).
Results: There were 30 DCRs performed on 30 patients (12 male, 18 female). The average age of the patients was 30 years (range 19-40 years). Common presentations were epi-phora (95%) and/or mucocele (7%) and/or pyocele 3.3%. Septoplasty was required in 6 patients (20%). The surgery was anatomically successful in 28 cases (93.3%), but in 3 of them symptoms still present, so overall clinical success is present in 25 cases (83.3%).
Conclusion: Endonasal DCR involves creation of a large ostium using microdrill and mucosal preservation for the construction of flaps. The anatomical success is 93.3% and is better than external DCR. Creation of a large ostium as well as mucosal flaps improves the efficacy of this endonasal technique.