Causes of Dacryocystorhinostomy Failure: External versus Endoscopic Approach

Lin, Guojian; Brook, Christopher; Hatton, Mark P.; Metson, Ralph

doi:10.2500/ajra.2017.31.4425

Cited by 36 publications

(27 citation statements)

References 21 publications

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“…[ 24 ] Lin GC reported the causes of failure DCR of 53 consecutive patients underwent EN-DCR revision surgeries and found 9.5% vs. 9.4% sump syndrome in EX-DCR and EN-DCR, respectively. [ 25 ] Sump syndrome was noted in one of the revision cases in our study. This might explain those who revealed functional failure despite anatomical patency.…”

Section: Discussionmentioning

confidence: 55%

Comparison of endoscopic and external dacryocystorhinostomy for treatment of primary acquired nasolacrimal duct obstruction

2018

Taiwan J Ophthalmol

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PURPOSE:The purpose of this study is to compare the success rates of endoscopic endonasal dacryocystorhinostomy (EN-DCR) and external DCR (EX-DCR) for the treatment of primary acquired nasolacrimal duct obstruction (PANLDO).DESIGN:This was a retrospective, comparative, nonrandomized clinical study.METHODS:Reviewed medical records of PANLDO underwent DCR at Far-Eastern Memorial Hospital from May 2011 to June 2017. Data regarding the lacrimal passage system, comorbidities, surgical outcomes, and postoperative complications were analyzed. Anatomical success was defined as patency confirmed by intranasal endoscopic inspection of the ostium and successful lacrimal irrigation; functional success was defined as complete resolution of epiphora and positive fluorescein dye disappearance test, which were assessed at postoperative 6th months.RESULTS:One hundred and seventy patients (37 males, 133 females, mean age 57 years) underwent 178 DCR surgeries for PANLDO. The overall anatomical success rate was 94.4% (93.5% in EN-DCR vs. 95.8% in EX-DCR, P = 0.511) and functional success rate was 90.4% (90.7% in EN-DCR and 90.1% in EX-DCR, P = 0.909). Surgical outcomes were comparable between two groups. Complication rate was low in both groups, including 11 cases of early canalicular stent dislodge (7 in EN-DCR, 4 in EX-DCR), one case of postoperative nasal bleeding in EN-DCR, and two skin wound dehiscence and three cutaneous keloid formation in EX-DCR. None of these cases were concluded into surgical failure at the final visit. The time to symptoms relief was statistical significantly shorter in EN-DCR group (1.7 vs. 3.7 weeks in EX-DCR, P < 0.001).CONCLUSIONS:Success rate of DCR for PANLDO in our study was high, and complication rate was low for both endoscopic and external approaches. There was no statistically significant difference between them. EN-DCR provided higher satisfaction due to quicker recovery and lack of external incision. Endoscopic DCR should be considered as the primary treatment of choice for PANLDO.

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Section: Discussionmentioning

confidence: 55%

Comparison of endoscopic and external dacryocystorhinostomy for treatment of primary acquired nasolacrimal duct obstruction

2018

Taiwan J Ophthalmol

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“…Several studies have commented on findings in patients with unsuccessful DCR. [16][17][18][19][20][21][22][23][24] Although a small or malpositioned bony opening has been described, the current literature lacks sufficient thorough analysis of how surgeons miss the appropriate DCR site in different case scenarios. Systematic removal of the anterior part of UP has been shown to correlate with high success in endo-DCR.…”

Section: Discussionmentioning

confidence: 99%

“…10 Endo-DCR has significant cosmetic and functional advantages over the external approach, including the absence of the external scar, intact orbicularis oculi muscle and medial canthal ligament, less bleeding and less hospital stay, 11,12 as well as adjuvant intranasal procedures that can be simultaneously performed, such as septoplasty, turbinoplasty, and endoscopic sinus surgery. [13][14][15] Several reasons for failure in both endoscopic and external DCR have been reported, including inappropriate site of the rhinostoma, cicatricial closure of the lacrimal ostium, granulation tissue formation, intranasal adhesions, presence of underlying intranasal pathology such as deviated nasal septum, and chronic sinusitis, [16][17][18][19][20][21][22][23][24] in addition to functional obstruction. 25,26 Although several studies have commented on these etiologies, the detailed description of computed tomography (CT) findings, including analysis of sinonasal anatomical structures in failed DCR, remains to be elucidated.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic and Radiologic Findings in Failed Dacryocystorhinostomy: Teaching Pearls for Success

Herzallah

Marglani

Muathen

et al. 2018

Am J Rhinol�Allergy

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Background Although several studies have commented on causes of dacryocystorhinostomy (DCR) failure, detailed description of anatomical findings in such cases remains insufficient. Objective Our objective was primarily to analyze radiologic, endoscopic, and intraoperative findings in patients presenting with failed DCR and secondarily to assess the outcome of revision endoscopic DCR (endo-DCR) carried out at our institution. Methods Twenty-four failed DCRs presenting to our tertiary care center were retrospectively analyzed. Data collection included patients’ history, diagnostic, and management data, as well as thorough analysis of sinonasal CT scans, along with endoscopic and intraoperative findings. Outcome was also assessed in 21 cases with revision endo-DCR performed. Results The anterior part of uncinate process was not previously removed in 15 sides (62.5%), with unopened agger nasi in 13 sides (54.2%). The lacrimal bone was detected covering the posterior sac despite removal of the anterior ascending process of maxilla in 9 sides (37.5%). Rhinostoma was anterior to lacrimal sac in 2 sides (8.3%) and was below the sac in 7 sides (29.2%). Fibrous membrane covered the rhinostoma despite removal of all sac-overlying bones in 6 sides (25%). Other findings included intranasal adhesions, septal deviation, lateralized middle turbinate, granulation tissue, foreign body reaction, and chronic sinusitis. Nineteen of the 21 revision endo-DCRs were successful (90.5%). Conclusion This study provides a precise anatomical description of findings in cases of failed DCR. Such information is paramount in helping surgeons enhance their learning curve, refine the surgical technique, and improve patients’ outcome.

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“…We think that relapses may occur more frequently when a clinic initially offers intranasal DCR treatment; in clinics with experienced surgeons, there is no difference between the recurrence rates of the two methods. From the literature, where DCR operations using both external and endoscopic approaches have been performed and the patients that failed were evaluated, intranasal adhesions were more frequent in the external DCR group; however, it was observed that intranasal pathologies were not evaluated …”

Section: Discussionmentioning

confidence: 97%

Endoscopic approach in one hundred and seventy‐nine patients of dacryocystorhinostomy

Turan

Ersoz

Ozhan

2018

Clinical Otolaryngology

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Causes of Dacryocystorhinostomy Failure: External versus Endoscopic Approach

Cited by 36 publications

References 21 publications

Comparison of endoscopic and external dacryocystorhinostomy for treatment of primary acquired nasolacrimal duct obstruction

Comparison of endoscopic and external dacryocystorhinostomy for treatment of primary acquired nasolacrimal duct obstruction

Endoscopic and Radiologic Findings in Failed Dacryocystorhinostomy: Teaching Pearls for Success

Endoscopic approach in one hundred and seventy‐nine patients of dacryocystorhinostomy

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