A prospective study was conducted on 84 patients of nasolacrimal duct obstruction with chronic dacryocystitis. Guided repair of canalicular laceration, case report pao free paper. Paediatric endoscopic and external dcr have similar success rates of around 8396%. This is a new technique that involves creation of a large rhinostomy and mucosal flaps. The purpose of this study is to describe the approach and success rate with endonasal dcr in which nasal mucosa, bone, and lacrimal sac mucosa. Endoscopic dacryocystorhinostomy videos oculoplastic. Endonasal endoscopic dacryocystorhinostomy in the paediatric. In young children, smaller spaces and relatively larger inferior turbinates may limit the size of the telescope and other instruments, which can result in a more technically challenging procedure. This study wa s done in a tertiary teaching hospital where 210. Nov 30, 2011 advantage of endonasal dcr over preliminary report. Endoscopic dacryocystorhinostomy oculoplastic eyelid orbit.
Because of difficulty in visualizing the nasal cavity, the endonasal approach fell out of favor, and for the next 100 years, a slightly modified external approach remained the treatment of choice for primary acquired nasolacrimal duct obstructions pando. Objectiveto assess the results of microsurgical endonasal dacryocystorhinostomy with longterm insertion of single or double bicanalicular silicone tubes in can. Jorge gc, alfonso ub 2001 nasolacrimal duct obstruction. Endoscopic endonasal dacryocystorhinostomy an upcoming modality. Endolacrimal ktp laserassisted dacryocystorhinostomy. In case of functional obstruction as evidenced by free flow on syringing along with failure of the pump system. Hence endoscopic endonasal dcr surgery should be considered for primary treatment of nasolacrimal duct obstruction. Oct 25, 2017 the main advantages of an endonasal approach dcr include the absence of a visible scar, minimal postoperative morbidity, faster recovery and comparable success rates to that of external dcr. Mri evaluation of lacrimal drainage after external and. Despite ease and decreased morbidity of endonasal dcr, external dcr is the procedure of choice as it is more successful. A comparison of endonasal dacryocystorhinostomy and external. Feb, 2015 we use a standard endoscopic dcr technique with an endonasal approach using 2. The aim of study is to evaluate the endoscopic dacryocystorhinostomy dcr with conventional instruments, its results and advantage over external dacryocystorhinostomy dcr. Understanding endonasal anatomy, wide endoscopic marsupialisation of the lacrimal sac, and meticulous care of the.
This study is undertaken to evaluate the efficacy of endonasal dcr in terms of successful outcome, intraoperative and postoperative complications. Endonasal dcr surgeries endoscopic endonasal dcr or dacryocystorhinostomy is the operation of choice for watering eyes from tear duct narrowing or full obstruction. 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. During recent years endonasal dcr was developed as an alternative surgical technique.
A comparison of endonasal dacryocystorhinostomy with and. In contrast, there was no statistically significant correlation between use of icg gel and anatomic success rate of endoscopic endonasal dcr. Endonasal dcr may be useful in the management of nld obstruction associated with previous paranasal sinus surgery or trauma in selected patients. There are numerous variations of endonasal dcr described in the literature that report variable success rates. Excessive tearing or troublesome watering with tears overflowing down the cheek can have many different dcrcauses, and there are several different surgical options, including dcr surgery. The third study reported that nonlaser endonasal dcr was superior to external dcr 84% vs.
Dec 01, 2001 endonasal dcr may be useful in the management of nld obstruction associated with previous paranasal sinus surgery or trauma in selected patients. A comparison of endonasal dacryocystorhinostomy and. Outcomes of endonasal dacryocystorhinostomy without. The remainder of the studies did not find statistically significant differences in success rates between the 2 techniques. Dcr for which the endonasal dcr has been gaining popularity for last few decades. Endoscopic, endonasal, or transnasal dacryocystorhinostomy. 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. The leading pdf viewer to print, sign, and annotate pdfs. Mar 23, 2017 indications of dcr symptomatic distal obstruction of the nasolacrimal duct that is not relieved by simple probing and syringing.
Endonasal dcr is a successful intervention with demonstrable health benefits to the patient. It facilitates direct drainage of lacrimal fluid into nose eliminating pooling of tears in lacrimal sac. Convert any file to pdf or convert from pdf to other formats. The tear sac can be reached from inside the nose endonasal dcr or from the skin between your eye and nose. The advantage of the endonasal approach is the short procedure time and the exemption of. From our population n30, 5 cases needed a revision surgery and 2 cases underwent a second revision dcr.
It is not indicated as the sole procedure where the site of obstruction lies in the canaliculi or puncti. This narrated video of a section of an endonasal dcr demonstrates anatomical variation of the location of the suture line between the frontal process of the maxillary bone and the lacrimal bone. His group also found the nasal approach more rapid and more acceptable to patients who had an alternative technique used on the other side. Use of laser for dacrocystorhinostomy external eye. The study involved prospective interventional case series with short perioperative follow up. The functional success rate of endoscopic endonasal dcr reached 93. Pdf chronic dacryocystitis occurs usually due to obstruction of lacrimal passage at the.
Endonasal dacryocystorhinostomy the standard dacryocystorhinostomy operation performed in this centre uses silicone tubes to stent open the newly created ostium between the lacrimal sac and the nasal cavity. Pdf a comparison of external and endoscopic endonasal. A literature search was conducted in the pubmed database in march 2016 and updated in october 2017 and february 2019. Primary external dacryocystorhinostomy versus primary. Success rate and complications of endonasal dacryocystorhinostomy with. Nonendoscopic endonasal dacryocystorhinostomy springerlink. Clinical evaluation of failed endonasal dcr operations and. The introduction of endonasal laser dacryocystorhinostomy enl dcr in the early 1990s showed great promise of changing dacryocystorhinostomy into an elegant, minimally invasive procedure from the. In addition to these, there are certain advantages of nonendoscopic endonasal approach in comparison to endoscopic approaches. A modified preserved nasal and lacrimal flap technique in. The success rates for endonasal dacryocystorhinostomy. This video demonstrates a simplified bone removal technique in endoscopic endonasal dcr without powered instrumentation. Jul 28, 2017 the incidence of complications in endonasal dcr is not high, but has been reported. Complication rates were low in both types of surgery.
They are similar operations with similar success rates. In group 2, endoscopic primary endonasal dcr with hammerchisel removal of bone located over the lacrimal sac was performed in 51 eyes of 36 patients, 33 women and 3 men 15 bilateral procedures. Article information, pdf download for endoscopic and radiologic findings in. Endonasal dacryocystorhinostomy of lacrimal sac and nasolacrimal duct. Primary endonasal endoscopic powered dacryocystorhinostomy. Endonasal dcr can be performed with the help of rigid endoscopes or under binocular operating microscopes. This video describes the surgery, endoscopic dcr, done for chronic dacryocystitis. This study was done to assess the efficacy of powered endoscopic dacryocystorhinostomy dcr with creation of a large bony ostium exposing fundus of the sac and primary mucosal anastomosis. Pooled results showed that both surgical approaches had similar success rates endoscopic endonasal dcr 82. Efficacy of endo nasal dcr in primary nasolacrimal duct. A small incision is made on the side of the nose and some bone is removed to make a connection to the nose. Endoscopic endonasal dcr plays an established role in revision dcr surgery. Successful external dcr creates a 24mm ostium on average regardless of bony osteotomy size bumsted, arch otolaryngol 1982. Endonasal dacrocystorhinostomy dcr was first introduced in 1893 by caldwell 2 and then later modified.
Pdf stepbystep dacryocystorhinostomy for beginners. Mechanical endonasal dacryocystorhinostomy with mucosal. The success rate was 91% for the external dcr group in both reports and 63% and 75% for the endonasal dcr groups, defined by patency to irrigation. Dcr is sometimes required for paediatric congenital or acquired nasolacrimal duct obstruction. Endoscopic endonasal surgery should be considered in patients. 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 this procedure. A prospective series of 104 consecutive endonasal dcrs performed from january 1999 to. Therefore, ext dcr was the most widely accepted modality for treatment for almost. Sep 25, 20 using an endoscope, the dcr can be performed by endonasal route using either laser 4,5 or surgical instruments 6,7 or both. Endonasal dcr broadly refers to the approach from inside the nose, including the speculum or endoscope view. Endonasal dcr since puncta canaliculus are not heated or emedicine 7. Endonasal dcr, powered dcr, dacryocystorhinostomy introduction dacryocystorhinostomy dcr is surgical procedure done for epiphora due to nasolacrimal duct obstruction nldo, which involves creating a fistulous opening between the lacrimal sac and the nasal cavity at the level of the middle meatus. The anatomy and technique of endo dcr in general is explored in more detail in.
The most common cause of paediatric epiphora is congenital nasolacrimal duct obstruction. Adobe adobe acrobat reader dc download free pdf viewer. Endonasal dcr or from the skin between your eye and nose. Laser dcr is in follow up cases, less failures following 3739.
External dcr the operation takes place through a 10 15mm incision in the side of your nose, where a pair of glasses would rest. Jun 11, 2010 a disadvantage of endonasal dcr is the steep learning curve. Patients suffering from a low obstruction of the lachrymal system documented by paraclinical investigations. Simple bone removal technique in endonasal dcrendoscopic. Patient information adnexal dacryocystorhinostomy dcr. To compare success rates of external dacryocystorhinostomy dcr and endoscopic endonasal dcr for acquired nasolacrimal duct obstruction nldo. Endonasal dcr is the procedure of choice in previously unsuccessful external dcr as laborious dissection of the scarred tissue is avoided and the operating time is still 30 minutes. To describe and assess the efficacy of mechanical endonasal dacryocystorhinostomy mendcr. External versus endonasal dacryocystorhinostomy in a. This included three patients with postoperative hemorrhage two who had endonasal dcr surgery and one having external dcr surgery. A comparison of external and endoscopic endonasal dacryocystorhinostomy for acquired nasolacrimal duct obstruction r karim, r ghabrial, tf lynch, b tangschool of public health, faculty of medicine, university of sydney, sydney, australiapurpose. Pdf endoscopic endonasal dacryocystorhinostomy an upcoming. There was free flow to the nose when one drop of 2% fluorescein was put in the.
His dacryocystorhinostomy through an endonasal approach evaded popularity. Bilateral endonasal endoscopic dcr was performed in 5 patients, with a total of 35 primary dcrs in our group. Dacryocystorhinostomy, endoscopy, endo injury to the discrete fistula site without disruption of nasal, co2 laser, silicone tubing the medial canthal anatomy and function 9,10,12. Endoscopic dacryocystorhinostomy oculoplastic eyelid. Mechanical endonasal dacryocystorhinostomy with mucosal flaps. Outcomes of endonasal dacryocystorhinostomy without mucosal.
This requires removal of the small amount of bone that lies between your tear sac and your nose. Caldwell 1 and toti 2, respectively, described the endonasal and external approaches to dacryocystorhinostomy dcr 1, 2. Limited data suggest that laser endonasal dcr may be less effective than external dcr. To assess the efficacy of endonasal dacryocystorhinostomy dcr compared with external dcr. Methods this is a retrospective, nonrandomized case series. Conventional external dcr ext dcr was described in 1904 by toti. Endonasal dacryocystorhinostomy ota american academy of. Original article, report by journal of evolution of medical and dental sciences. Endonasal dacryocystorhinostomy dcr has been widely used to.
To compare success rates of external dacryocystorhinostomy dcr and endoscopic endonasal dcr for acquired nasolacrimal duct. Compared with external dcr, endoscopic dcr is more. B were free of clinical symptoms tearing during the followup period. Failing or failed endonasal dcr can occur from mucosal stenosis at the ostium. Eight adult patients who suffered in the past from postsaccalacquired nasolacrimal duct obstruction without canalicular stenosis and who had undergone successful ex dcr 4 cases or successful en dcr 4 cases were included.
Endoscopic dacryocystorhinostomy with conventional. Depending on the preference of the surgeon, more postoperative care may be required for patients undergoing endonasal dcr than. A longitudinal cohort study included a control group of agematched external dcr patients who were compared with a study group of endonasal dcr patients. This article tries to provide few tips to make dcr easy and stress free. Use of laser for dacrocystorhinostomy external eye disease. The aim of this retrospective study was to describe the outcomes of powered endonasal endoscopic dacryocystorhinostomy dcr performed for symptomatic low lachrymal obstruction in adult patients over a 5year period by the same surgeon methods. Repeat endonasal dcr with or without mitomycin c can be considered. A lot of ophthalmologists fear performing dcr because of bleeding and unfamiliarity of structure.
The success of primary endonasal dcr compares favourably with that of external dcr. Simple bone removal technique in endonasal dcrendoscopic dcr. Clinical evaluation of failed endonasal dcr operations and their management. Ex dcr or endoscopic endonasal dacryocystorhinostomy ee dcr combined with laser or intubation or both 345. Do everything you can do in acrobat reader, plus create, protect, convert and edit your pdfs with a 7day free trial. Nov 05, 2008 endonasal dcr without silicone tubes this is the intervention arm procedure. Pdf endonasal dacryocystorhinostomy, our experience. 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. Perform highquality pdf conversions by adjusting page size, margins, and orientation. Despite ease and decreased morbidity of endonasal dcr, external dcr is. We found that 14 46,7% patients had comorbidities, including concomitant sinonasal pathology was present in 12 40%. The study group comprised of 127 patients who underwent consecutive endoscopic. Pdf to compare success rates of external dacryocystorhinostomy dcr and. 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 abnormal tearing or epiphora watery eyes takes place due to obstruction in the drainage system of.
Operative and postoperative data were prospectively collected on 42 patients 15 men and. The advantage of the endonasal approach is the short procedure time and the exemption of an external skin incision. The study involved a prospective nonrandomised interventional case series with short perioperative follow up. The impact of endonasal dacryocystorhinostomy dcr, on. The main advantages of endonasal dcr include the absence of a visible scar, minimal postoperative morbidity, faster recovery, and success rates 90% comparable to that of ext dcr. Dcr involves opening up your existing tear sac and connecting it directly into the nose to form a new tear drainage pathway.
Dcr and endoscopic endonasal dcr, often referred to as endodcr. Indications of dcr symptomatic distal obstruction of the nasolacrimal duct that is not relieved by simple probing and syringing. Health, general dacryocystorhinostomy analysis complications and side effects lacrimal apparatus usage lacrimal organs mitomycin. This article tries to provide few tips to make dcr easy and stressf. Endoscopic dacryocystorhinostomy dcr surgical technique hisham wasl, darlene lubbe endoscopic dacryocystorhinostomy dcr is a surgical intervention for epiphora caused by obstruction of the nasolacrimal duct. This heals up very quickly and is rarely visible when healing is complete. Microsurgical endonasal dacryocystorhinostomy with longterm. Mcdonogh and meiring described the first modern endonasal dcr procedure. This occurs due to the persistence of a membrane at the level of. Abnormal tearing or epiphora watery eyes takes place due to obstruction in.
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