Endolacrimal ktp laserassisted dacryocystorhinostomy. To determine whether acute dacryocystitis complicated by abscess formation can be successfully treated using laser assisted endonasal dacryocystorhinostomy. Endonasal dcr is safely performed in children presenting with persistent epiphora, not responding to conservative management. We have now tested this in a prospective series of 100 consecutive patients, candidates for endonasal dcr. Endonasal dacryocystorhinostomy with mucosal flaps. Endoscopic endonasal dcr has evolved from functional endoscopic sinus surgery. Endonasal dacryocystorhinostomy in wegener granulomatosis. Paediatric endonasal dacryocystorhinostomy using an otology. Dacrocystorhinostomy dcr was historically performed by ophthalmologists for nasolacrimal obstruction using external techniques. This included three patients with postoperative hemorrhage two who had endonasal dcr surgery and one having external dcr surgery. Silicon tubing is a controversial issue in the literature. A prospective series of 104 consecutive endonasal dcrs. All patients were assessed jointly by an ophthalmologist and otolaryngologist for their suitability for. Endoscopic dcr is also technically more difficult to learn, and the learning curve for the endoscopic procedure has been reported in several studies.
Volume 123, issue 10, october 2016, pages 22552259. To assess the subjective success and quality of life of adult patients post endoscopic endonasal dacryocystorhinostomy ee dcr for acquired nasolacrimal duct obstruction. Use of laser for dacrocystorhinostomy external eye disease. The success rates for mechanical endonasal dcr reported by tsirbas and wormald 1 appear to be very good 95% anatomical and 89% functional success, but their follow up period varied from only 2 months to 28 months mean 9.
Several ophthalmologists fear performing dcr because of bleeding and unfamiliarity of structure. Mar 11, 2011 to investigate the effects of merogel coverage on ostial patency in endonasal endoscopic dacryocystorhinostomy ees dcr for primary chronic dacryocystitis pcd. This study was carried out to evaluate the results of endonasal dcr surgery and to access efficacy of this procedure without stenting. Background endonasal dacryocystorhinostomy dcr has been widely used to treat nasolacrimal duct obstruction. This is a new technique that involves creation of a large rhinostomy and mucosal flaps. To circumvent the disadvantages of endoscopic dacryocystorhinostomy such as small rhinostomy size, high failure rate and expensive equipment, we hereby introduce a modified technique of nonendoscopic mechanical endonasal dacryocystorhinostomy. To describe and assess the efficacy of mechanical endonasal dacryocystorhinostomy mendcr. The advantage of the endonasal approach is the short procedure time and the exemption of an external skin incision. To study the duration of surgery, outcomes, adverse events and success rates of external versus endonasal dacryocystorhinostomy dcr surgery in a specialized lacrimal surgery center. Idiopathic acquired dacryocystocele treated with endonasal. Dcr involves opening up your existing tear sac and connecting it directly into the nose to form a new tear drainage pathway.
Endonasal dcr can be performed with the help of rigid endoscopes or under binocular operating microscopes. Disadvantages of endonasal dcr include the preferred use of general anesthesia by many surgeons, the high cost of expensive equipment and instrumentation, and the relatively steep learning curve for. Jul 12, 20 to assess the subjective success and quality of life of adult patients post endoscopic endonasal dacryocystorhinostomy eedcr for acquired nasolacrimal duct obstruction. In this interesting article, our experienced colleagues describe their favoured technique for performing endoscopic dcr and share with us the key steps for a successful outcome dacrocystorhinostomy dcr was historically performed by ophthalmologists for nasolacrimal obstruction using external techniques. The treatment of acute dacryocystitis using laser assisted. The success rates for endonasal dacryocystorhinostomy.
Some of the patients who had only a short follow up time may subsequently fail. Though success rates are higher with external dcr, endonasal endoscopic laser dcr offers certain advantages over the external approach while keeping the option of external dcr. Endoscopic endonasal dacryocystorhinostomy dcr is the best, scar free no scar, lacrimal surgery performed for restoration of tears flow into the nose from the lacrimal sac, when the nasolacrimal duct tear duct has become blocked blocked tear duct tear duct obstruction. This article tries to provide few tips to make dcr easy and stressfree. To focus on difficulties in endoscopic endonasal dcr, to improve the final outcome of endoscopic. Complication rates were low in both types of surgery. Patient satisfaction was significantly higher in the endonasal dcr group 9. Endonasal endoscopic dacryocystorhinostomy in children. Comparison of different surgical methods in endonasal. To compare success rates of external dacryocystorhinostomy dcr and endoscopic endonasal dcr for acquired nasolacrimal duct obstruction.
Endoscopic endonasal dcr has evolved from functional endoscopic sinus surgery and can be performed either with. Historically dacryocystorhinostomy dcr has been performed externally with very good outcomes. The first intranasal dcr was described by caldwell in 1893. The advantage of the endonasal approach is the short procedure time and the exemption of. Endoscopic dacryocystorhinostomy oculoplastic eyelid orbit. Mechanical endonasal dacryocystorhinostomy with mucosal. Our experience endonasal dacryocystorhinostomy is considered to be the standard treatment for chronic dacryocystitis, and is simple to perform and is very effective even in patients. In most series reported, it appears that end dcr had a higher failure rate than ext dcr. Endonasal dcr is a safe and effective procedure in children indicated only when the conservative management fails. Comparison of external dacryocystorhinostomy with nonlaser endonasal. Pediatric endonasal endoscopic dcr is a very safe and effective procedure for the correction of a common cnldo when medical therapy, probing, and silicone intubation have been unsuccessful.
New techniques such as endonasal laserassisted dcr eladcr, silicone intubation, endocanalicular laser, and balloon catheter dilation have also recently been introduced. Endoscopic endonasal dcr plays an established role in revision dcr surgery. To study the outcome of endonasal endoscopic dacryocystorhinostomy dcr with or without mucosal flap preservation, without mitomycin local application, silicon tube stenting or laser assistance. A nasal mucosa flap is first created, followed by endonasal bone osteotomy to expose the lacrimal sac and its marsupialization to inside the nasal. Systematic unciformectomy for a standardized endonasal. Tsirbas and wormald are to be congratulated on their landmark paper in lacrimal surgery describing endonasal dacryocystorhinostomy dcr with mucosal flaps,1 which is also known as powered endonasal dcr. Endonasal dacryocystorhinostomy is considered to be the standard treatment for chronic dacryocystitis, and is simple to perform and is very effective even in patients with complications like abscess, fistula periorbital cellulitis. A protocol was adopted for the management of acute dacryocystitis presenting to an ophthalmology department. Use of an imageguided navigation system for routine endonasal endoscopic dacryocystorhinostomy volume 3 issue 8 o reichel, m taxeidis. In either situation, only one patient each had partial block of the nasolacrimal fi stula. Use of an imageguided navigation system for routine. Endoscopic dcr using bipedicled interlacing mucosal flaps. Dacryocystorhinostomy dcr is an operation indicated for nasolacrimal duct obstruction. All patients were assessed jointly by an ophthalmologist and otolaryngologist for their suitability for primary.
This requires removal of the small amount of bone that lies between your tear sac and your nose. The study involved a prospective nonrandomised interventional case series with short perioperative follow up. In our study, we under took bone removal with kerrisons 2 mm punch. Endoscopic dacryocystorhinostomy bjorl brazilian journal of. We use cookies to offer you a better experience, personalize content, tailor advertising, provide social media features, and better understand the use of our services. Methods this is a retrospective, nonrandomized case. Seckin ulusoy1, meltem erden2, hulya yuksel3, erdem calar1, mehmet emre dinc1, abdullah dalgc1. Excellent outcome is attained in children by using a wider 4 mm endoscope at the cost of miniaturization of instruments.
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. A small incision is made on the side of the nose and some bone is removed to make a connection to the nose. An endonasal operative approach to the lacrimal system was first described by caldwell in 1893, 1 modified by west in 1910, 2 and advocated by mosher in 1921. Effects of merogel coverage on wound healing and ostial.
The authors suggest that creation of a large ostium as. The anatomical success is 95% and is similar to external dcr and better then other endonasal approaches. Mar 23, 2017 endoscopic dcr dacryocystorhinostomy 1. Comparison of external and endonasal dacryocystorhinostomy.
Bicanalicular silicone stents in endonasal dacryocystorhinostomy. Comparison of external dacryocystorhinostomy with nonlaser. Nov 30, 2011 endonasal endoscopic dcr is the best at present treatment of dcr. Pdf endonasal dacryocystorhinostomy with mucosal flaps.
A comparative study rajeev reddy1, prajwalli reddy2 1associate professor, department of ent, kbn medical college, kalaburagi, karnataka, india, 2assistant professor, department of ophthalmology, mr medical college, kalaburagi, karnataka, india females are affected more than males, probably due to. It must be performed by a surgeon who has expertise in pediatric endonasal surgery and. To determine the duration of the surgical procedure of dcr, infl uence of simultaneously performed endonasal endoscopic procedures for concomitant sinonasal diseases. Abnormal tearing or epiphora watery eyes takes place due to obstruction in. Endoscopic dacryocystorhinostomy oculoplastic eyelid. Mri evaluation of lacrimal drainage after external and. Oct 04, 20 despite much debate, many still believe that external dcr provides a high success rates than endoscopic dcr though many types of endonasal approaches have been attempted, long term success rates are less than ext. Dacryocystorhinostomy dcr has been shown to be a safe, effective intervention 2,3 but failures and complications are more common in this patient group. Conclusion endonasal endoscopic dcr is a viable alternative to external dcr, coexisting sinonasal diseases can be managed simultaneously, as may be required in 25% of cases. External versus endonasal dacryocystorhinostomy in a specialized. Use of laser for dacrocystorhinostomy external eye. Uncontrolled epithelialization of the surgical site as compared with. It creates a lacrimal drainage pathway into the nasal cavity to.
The surgical technique of endoscopic dcr in the paediatric age group essentially remains the same as that performed in adults, but children have narrower nasal passages and relatively larger inferior turbinates which limit the surgeons working space. Pediatric endonasal endoscopic dacryocystorhinostomy. Drivers and software updates for dcrtrv260 sony usa. Here, we evaluated the anatomical advantages of the uncinate process as a landmark and to study the effect of unciformectomy on success rate and complications of endonasal dcr. A prospective series of 104 consecutive endonasal dcrs performed from january 1999 to. Average duration of the surgical procedure of dcr was 18 min. During recent years endonasal dcr was developed as an alternative surgical technique. Pooled results showed that both surgical approaches had similar success rates endoscopic endonasal dcr 82. Results could prove useful in understanding the role of the lacrimal pump after dcr and associated differences between the external and the endonasal approaches.
Oct 31, 2018 in this interesting article, our experienced colleagues describe their favoured technique for performing endoscopic dcr and share with us the key steps for a successful outcome. Under endoscopic guidance nasal anatomy is understood directly, managed accordingly, sac is approached directly under vision and so at the time of surgery result is known. Endonasal dcr surgery was found to be quicker to perform than external dcr surgery. Endonasal dacryocystorhinostomy is widely accepted and effective treatment option for nasolacrimal duct obstruction. Endoscopic endonasal dcr has evolved from functional endoscopic sinus surgery and can be performed either with surgical instruments or. Dacryocystorhinostomy dcr is a surgical procedure to restore the flow of tears into the nose from the lacrimal sac when the nasolacrimal duct does not function. Comparison of external dacryocystorhinostomy with nonlaser endonasal dacryocystorhinostomy.
In the case of cicatricial obstruction at the osteotomy site, it is easier to perform endoscopic revision, and the patient is more likely to accept such a revision without visible external cuts. A ct revealed a nonenhancing, low density, cystic lesion in the inferomedial aspect of the left orbit without bony erosion, which was compatible with an idiopathic acquired dacryocystocele. Despite much debate, many still believe that external dcr provides a high success rates than endoscopic dcr though many types of endonasal approaches have been attempted, long term success rates are less than ext. Dec 27, 2019 download pdf introduction endoscopic dacryocystorhinostomy edcr is a currently wellestablished surgical treatment for patients with nasolacrimal duct obstruction nldo. Mechanical endonasal dacryocystorhinostomy with mucosal flaps. Caldwell, west and mosher replaced endonasal dcr in early 1900 5, 6, 7. Find firmware updates, drivers and software downloads for dcr trv260. We therefore postulated that the up could be a reliable landmark for the medial aspect of the lacrimal fossa, and thus form part of a standardized osteotomy technique to improve the reproducibility of endonasal dcr. Reported complications of endonasal dcr do not generally appear to be greater in frequency or magnitude than those associated with external dcr. Comparison of external and endonasal dacryocystorhinostomy volume 123 issue 3 m feretis, j r newton, b ram, f green. Endoscopic endonasal dcr has evolved from functional endoscopic sinus surgery and can be performed either with surgical instruments or using a laser.
Endonasal endoscopic dcr is the best at present treatment of dcr. However, it is difficult to compare the success rate for primary surgery between external dcr and endoscopic endonasal procedures, as there are few comparative studies. The tear sac can be reached from inside the nose endonasal dcr or from the skin between your eye and nose. A comparison of external and endoscopic endonasal ncbi. External versus endonasal dacryocystorhinostomy in a. To prospectively compare the quality of life of adult patients who underwent either an endonasal or an external dcr for acquired nasolacrimal. Surgical outcomes of endoscopic dacryocystorhinostomy. This new technique of endonasal dcr involves creation of a large ostium and construction of nasal and lacrimal sac mucosal flaps. The success rate of endonasal dcr was 98% in 117 cases 2, issue 2, february, 2015.
A common reason for the failure of a dcr is the reclosure of the nasolacrimal stoma by granulation tissue and synechiae. Objectives to study the outcome of endonasal endoscopic dacryocystorhinostomy dcr with or without mucosal fl ap preservation, without mitomycin local application, silicon tube stenting or laser assistance. Those that didnt respond to these measures were then posted for endoscopic dcr. Though success rates are higher with external dcr, endonasal endoscopic laser dcr offers certain advantages over the external approach while keeping the option of external dcr open, if needed at a. In the last 15 years, endonasal dacryocystorhinostomy end dcr has become an alternative to external dacryocystorhinostomy. Endonasal dacryocystorhinostomy ota american academy of.
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