Clinical Results of Endoscopic Dacryocystorhinostomy using a Microdebrider

Abstract

PurposeThe success rate of endoscopic dacryocystorhinostomy has been increasing with the development of better instruments and techniques. We conducted this study to evaluate the clinical results of endoscopic dacryocystorhinostomy using a Microdebrider, which has also been used for functional endoscopic sinus surgery.MethodsWe selected 76 patients (with a total of 84 affected eyes) who had been diagnosed with a nasolacrimal duct obstruction. These patients underwent an endoscopic dacryocystorhinostomy using a Microdebrider, which removed both nasal mucosa and lacrimal sac mucosa and also trimmed the margins of the ostotomy site. We assessed patients' outcomes on an anatomical basis using a dye test and endoscopy, which were used to define the anatomical success. We also arbitrarily defined functional success as whether the subjective epiphora was absent. At a four to 18 month follow-up, we monitored the clinical course to examine any recurrent episodesResultsThe symptoms were alleviated in 72 eyes, with a primary success rate of 85.7%. On nasal endoscopy, a functional failure was seen in four eyes. In these four eyes, the orifice was narrowed by the presence of either granulation tissue or conjunctivochalasis. By contrast, surgical outcomes were the anatomical failure in eight eyes. In these eight eyes, the orifice was obstructed by the presence of granulation tissue as well as the adhesion of nasal mucosa.ConclusionsEndoscopic dacryocystorhinostomy using a Microdebrider enabled us to make the large fistula while minimizing the damage of adjacent tissue. It might be the recommended surgery that reduces the complications and enhances the success rate.

Study of patient outcome in endoscopic dacrocystorhinosomy using a microdebrider in chronic dacryocystitis patients

“…Worse 0 0 0 0 Scores of 1, 2, and 3 are considered as successful while 4 and 5 as failed; POD: post-operative day. 12,14,15 This indicates that chronic dacryocystitis is more common in females as compared to males in adults.…”

“…[9][10][11] Yoon et al selected 76 patients (with a total of 84 affected eyes) who had been diagnosed with a nasolacrimal duct obstruction. 12 These patients underwent an endoscopic dacryocystorhinostomy using a microdebrider, According to their study the symptoms were alleviated in 72 eyes, with a primary success rate of 85.7%.…”

Success Rates in Powered Endonasal Revision Surgery for Failed Dacryocystorhinostomy in a Tertiary Referral Center

“…Its minimally invasive approach reduces complications by avoiding adjacent tissue damage and improves surgical outcomes. 21 It should only rarely be used at speeds above 3000 rpm and never directed toward the orbit. 22 It can be used at very low speeds to delicately and safely remove tissue.…”

“…10 12-19 60.0% Mathew (2004) 9 16 9 (16-21) 63.0% Metson (1991) 10 12 7-25 75.0% Ragab (2012) 11 76 12 80.6%-82.9% Paik (2012) 12 82 8 ± 2 SD 80.7%-84% Weidenbecher (1994) 13 11 Unknown 82% ElGuindy (2000) 14 18 14 (12)(13)(14)(15)(16)(17)(18)(19)(20) 83.3% Zeldovich (2009) 15 19 9 (1-15) 84% Korkut (2010) 16 44 11 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) 84.1% Puxeddu (2000) 17 8 18 (minimum) 87.5% Choussy (2010) 18 17 56 (14-148) 94%…”

Microdebrider Use in Orbital Surgery

“…2,3 New applications for this device continue to be developed, including recent reports in facial flap contouring 4 and endoscopic dacryocystorhinostomy. 5 Its use is now commonplace in endonasal surgery, although it has not previously been discussed in open orbital surgery. We report 3 cases in which the characteristics of the microdebrider were optimal to assist in the removal of difficult-to-handle orbital contents.…”