Early Experience Using a New Modified Bone Nibbler for Superior Osteotomy During Endonasal Dacryocystorhinostomy

Abstract

We report the use of a new modified bone nibbler for removal of superior bone, even as high as the nasal roof, which previously in our practice could be removed only with PI. It allows a large osteotomy comparable to that achieved with powered endoscopic dacryocystorhinostomy yet avoids the disposable costs of PI.

Osteotome as an Adjunctive Instrument in Endoscopic Dacryocystorhinostomy

“…Another advantage that this technique of the osteotome and mallet has over powered instruments is the tactile feedback and resistance present when using the ostetome, which may prevent excessive destruction that can occur with powered instruments. We do not have any experience with the new bone nibbler as described by Patel et al 16 In the previous study by Cokkeser et al 17 it was reported that the procedure could be completed within 15 minutes. Given the fact that the duration of our operation went down to 22 minutes after just 9 initial operations, it is likely that with greater familiarity, shorter operation times can be achieved.…”

Peri-orbital surgical emphysema following endoscopic dacryocystorhinostomy

“…Thus a large osteotomy can be created that fully exposes the lacrimal sac, from its fundus down to the nasolacrimal duct junction and the agger nasi air cells posterior to the sac. 9 This allows the lacrimal sac to be fully marsupialised and flaps opened flat, both anteriorly and posteriorly, using a standard crescent blade.…”

Tear Trough Malar Implant Penetrating Lacrimal Sac Causing Lacrimal Obstruction and Epiphora: Case Report and Review

“…Nasal endoscopy was normal apart from a narrow left nasal passage and deviated septum. The patient was recommended for left powered endonasal (DCR) 4 with septoplasty and intubation.…”