Endoscopic Dacryocystorhinostomy

Abstract

Endoscopic endonasal dacryocystorhinostomy is an effective treatment for nasolacrimal duct obstruction. An uncinectomy, septoplasty, and anterior middle turbinectomy contribute to the optimal clearance of the common canaliculus and ultimate surgical success.

No impact of nasal septoplasty on the outcome of endoscopic dacryocystorhinostomy

“…The reported rate of concomitant endoDCR and septoplasty for DNS is considerable, and ranges from 11.9 to 57%. [2,3,7,[13][14][15][16] In our series, the rate of concomitant endoDCR and septoplasty was 21.4% of patients who presented with NLDO. Our data showed that integrating an additional procedure (septoplasty) that was not performed for its original indication but rather for facilitating the main surgical intervention (endoDCR) yields results that are comparable with those for cases of endoDCR without septoplasty in terms of surgical success and complications.…”

“…Figueira et al [2] reported a large series of 576 patients who underwent endoDCR, of whom 81 had concomitant endonasal procedures (septoplasty, turbinectomy, and polypectomy): the results were similar to those for the nonconcomitant procedures, but there was no reference to septoplasty alone. Fayet et al [3] demonstrated that higher rates of anterior middle turbinectomies and septoplasties performed during endonasal DCRs yielded higher rates of elimination of epiphora, but, again, septoplasty was not evaluated in isolation and it comprised only one quarter of all the endonasal procedures in that series.…”

“…An endoscopic approach has the advantages of not requiring an external incision (as in the case for traditional external DCRs), preservation of the tear pump mechanism, and the ability to treat nasal comorbidities in order to improve the DCR outcome [1]. Concomitant deviation of the nasal septum (DNS) to the side of nasolacrimal duct obstruction (NLDO), however, may obscure visualization of the insertion of middle turbinate (axilla) to the lateral nasal wall and hinder exposure of the lacrimal sac fossa, thereby jeopardizing surgical success by an inadequate rhinostomy [2,3]. Previous reports have suggested that anatomical failure of external and endoDCRs may be attributed to severe septal deviation, among other nasal structural abnormalities [4,5].…”

“…The ability to perform a concomitant endoscopic septoplasty for correction of a DNS has been considered an additional advantage of endoDCR compared with the external approach by alleviating symptoms that may be related to DNS. More importantly, septoplasty can be performed to improve the execution and the outcome of the endoscopic DCR, even in patients lacking nasal obstruction symptoms [2,3,5,7].…”

Comparable anatomical and functional success to younger patients in endoscopic dacryocystorhinostomy patients of older age

“…The reported rate of concomitant EDCR and septoplasty ranges from 11.9 to 57% [11,[24][25][26][27][28][29][30][31]. Per the literature, 39.7% of our cases were managed with a combined procedure.…”