LNHsaturday

8/2/2019 LNHsaturday

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Khalid MahidaAssociate professor OtolaryngologyMohammad Ayub BhattiAssistant Professor Ophthalmology

Ziauddin University Karachi


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Overview


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It is procedure used to create a lacrimaldrainage pathway in to nasal cavity to

reestablish the permanent drainage ofobstructed excretory system


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External Dacryocystorhinostomy

Endoscopic Laser assisted DCR

Endoscopic Transnasal or Endonasal Non laser

Punch removal of bone

Powered instruments

Mucosal flap Preservation


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Is a commonly performed operation inwhich a fistulous tract is created between

the lacrimal sac and the nasal cavity inorder to relieve the epiphora due tonasolacrimal duct obstruction

Endoscopic DCR


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Epiphora caused by anatomic or functionallacrimal sac or nasolacrimal duct obstruction

Chronic dacryocystitis with purulent drainagefrom the canaliculi


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It provides a better aesthetic result with noexternal scar.

It allows a one-stage procedure to alsocorrect associated nasal pathology.

It avoids injury to the medial canthus.


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It preserves the pumping mechanism ofthe orbicularis oculi muscle.

Active infection of the lacrimal system isnot a contraindication to surgery.

It is especially superior to the externalapproach in revision surgery


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The perioperative time is shorter.

The success rate is comparable to theexternal approach.


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Specialized training in nasal endoscopicsurgery.

The endoscopic equipments are expensiveas compared to External DCR


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Epistaxis.

Orbital fat may be exposed.

Damage to the medial rectus and superioroblique may cause diplopia.


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Epistaxis

Infection in the nose or orbit

Adhesions

Pyogenic granulomata at the site of

rhinostomy


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Opthalmological examination ENT examination

Hematology Biochemistry

Dacryocystography


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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44


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Male 12 Female 32


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Unilateral 41 Bilateral 03


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Epiphora 44 Purulent Discharge 03

Medial canthal Swelling 19

Nasal Symptoms 10 Deviated Nasal Septum 16


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Negative 35 Externel DCR 09

Syringing and probing 43


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Hypertension and DM 03


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General Anesthesia Application of 1:1000 Adrenalin pack

Xylocain Adrenaline Injection to Lateral Nasalwall

20-gauge fiberoptic endoilluminator

Incision and elevation of Mucosa

Punch Removal of Bone and Medial wall of

Lacrimal sac


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Adhesions 05 None 39


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Symptom free 39 Mean duration 8.5 months

89%

19%


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Symptomatic Relief1st Week 2nd Week 6th week 10th Week

Complete

Relief

Partial relief

No relief


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EnDCR without stenting is effective for thetreatment of naso-lacrimal duct obstruction.

This procedure gives good anatomic and functionalresults, with low complication rates.

In the present series of 44 consecutive procedures,a functionally patent dacryocystorhinostomy wasachieved in 39 cases without the need fornasolacrimal stent insertion.

Taking into account the added cost and potentialmorbidity, we suggest that the use of nasolacrimalstents, in EnDCR, can be avoided.

LNHsaturday

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