Endonasal Dacryocystorhinostomy: A Modified Technique With Preservation of the Nasal and Lacrimal Mucosa

Abstract

This study validates the concept of preserving the lacrimal and nasal mucosa through an endoscopic approach to treat NLDO. Early and controlled lining of the fistula with mucosal flaps appears to prevent closure of the ostium and leads to a high success rate comparable with that of external dacryocystorhinostomy. This can be accomplished successfully with a manual osteotomy thus avoiding the use of power drills and burrs.

Endocanalicular Laser Dacryocystorhinostomy With Mucosal Flaps

“…This may lead to improper fistulization, healing by secondary intention, and cicatricial closure of the osteotomy site. As demonstrated by Codère et al, 7 the creation of mucosal flaps allows for more rapid and controlled epithelialization, thereby preventing secondary closure of the osteotomy site. By preserving the nasal and lacrimal mucosa, these investigators were able to achieve a success rate of 98% using the endonasal DCR approach.…”

“…Success rates have improved significantly since the introduction of mucosal flaps and, having reached 91% to 95%, are now equivalent to those of external DCR. [3][4][5][6][7] Endocanalicular laser DCR represents an attempt to improve on endonasal lacrimal surgery by creating the ostium from the lacrimal side via intubation of the canaliculus with a fiber-optic laser. Endocanalicular and endonasal DCR have the advantage of not violating the skin and underlying orbicularis muscle.…”

Endonasal dacryocystorhinostomy (DCR) without flap and stent (A new technique): Our experience in RIMS, Manipur

“…Some of the modifications that were described include various mucosal flap technique, marsupialization, application of mitomycin C, suturing of flaps using fibrin glue, using laser, using powered instruments and microdebrider, with/without uncinectomy, with stents, without stents etc [9,10,11,12,13,14,15,16,17,18,19] As the use of nasal endoscope has greatly increased the surgical field vision, DCR has become safer operation and it became easier to do post-operative assessment of the ostium to ascertain the ostium patency [20]. The minimal invasiveness of the procedure has made the procedure applicable during acute suppurative conditions too [21].…”

Acute Dacryocystitis with Empyema of the Lacrimal Sac: Is Immediate Endoscopic Dacryocystorhinostomy Justified?

“…We generally cover the bone by mucosal rotational flaps according to a technique that, with some minor differences, has already been described and is intended to favor primary intention healing. 11,12,20,21 When allowed by anatomic conditions, we harvest 4 flaps, with 2 obtained by extroversion of the lacrimal sac mucosa and 2 by a posteriorly based mucoperiosteal flap.…”