Dacriocistorrinostomia endoscópica nasal: resultados e vantagens sobre a abordagem externa

Abstract

A Dacriocistorrinostomia (DCR) consiste em criar uma via de drenagem lacrimal para a cavidade nasal, tendo como objetivo restabelecer a drenagem permanente deste sistema excretor previamente obstruído. OBJETIVO: Relatar nossos resultados com a técnica de DCR endoscópica, expondo vantagens e desvantagens em relação à técnica externa. FORMA DE ESTUDO: Coorte histórica. MATERIAL E MÉTODO: Foram analisadas retrospectivamente trinta e duas dacriocistorrinostomias realizadas pela Disciplina de Otorrinolaringologia de março de 2002 a janeiro de 2004 em pacientes com obstrução pós-saco lacrimal comprovada por dacriocistografia (DCG). Todos foram submetidos à sondagem com sonda de Crawford. RESULTADOS: Dos vinte e dois pacientes analisados, a cirurgia foi bilateral em dez totalizando trinta e dois procedimentos, sendo vinte e nove cirurgias primárias e três casos revisionais de insucessos com DCR externa. Nossa taxa de sucesso foi de 79,12%. CONCLUSÕES: A DCR endoscópica mostrou ser uma técnica segura, com baixa morbidade, além de evitar cicatrizes faciais e manter o mecanismo de bomba lacrimal, com resultados semelhantes à DCR externa.

Dacriocistorrinostomia endoscópica: nossa experiência e revisão de literatura

“…Obstruction of the lacrimal system can occur at any point along its path, being classified for surgical purposes as pre-saccal (obstruction of puncta, superior, inferior, and/or common canaliculi); saccal; or post-saccal (nasolacrimal duct). Thus, knowing the anatomy of the lacrimal system is essential to understand the conditions affecting the system and for diagnostic and therapeutic procedures (6) . Suspected obstruction can be confirmed by several tests, such as the Jones test (primary and secondary), the fluorescein test, and the Schirmer test.…”

“…Suspected obstruction can be confirmed by several tests, such as the Jones test (primary and secondary), the fluorescein test, and the Schirmer test. In daily practice, however, the most used tests are dacryoscintigraphy, dacryocystography and dacryotomography, which help predict the surgical prognosis depending on the contrast pattern of the lacrimal sac (6,7) . Dacryocystorhinostomy has been the treatment of choice for cases of distal obstruction of the lacrimal system (below the common canaliculus).…”

“…Dacryocystorhinostomy has been the treatment of choice for cases of distal obstruction of the lacrimal system (below the common canaliculus). The procedure consists in creating a communication between the lacrimal sac and the nasal cavity, allowing drainage of tears and therefore relieving symptoms (6,7) . The traditional treatment of nasolacrimal duct obstruction is external dacryocystorhinostomy, often performed by ophthalmologists.…”

“…The traditional treatment of nasolacrimal duct obstruction is external dacryocystorhinostomy, often performed by ophthalmologists. However, technological innovations and less invasive procedures on the lacrimal system have been developed, with reduced morbidity and improved results (6,7) . The endonasal approach was first described by Caldwell in 1893, but it was forgotten for decades due to the limited capacity to visualise and assess the sinonasal anatomy.…”

“…Yang et al (17) 1998 150 90 Cokkeser et al (7) 2000 51 88,2 Sham et al (18) 2000 17 88 Araujo Filho et al (2) 2004 17 82,3 Küpper et al (6) 2004 32 79,12 Ben Simon et al (19) ligaments and structures of the medial corner of the orbit, thus maintaining the physiological mechanisms of the lacrimal pump (13)(14)(15) . According to Cokkeser, dacryocystorhinostomy is successful in 70% to 95% (7) of cases, depending on a number of factors.…”