Endoscopic Transnasal Dacryocystorhinostomy and Bicanalicular Silicone Tube Intubation

Abstract

Purpose: To evaluate the results of endoscopic transnasal dacryocystorhinostomy (ETDCR) combined with bicanalicular silicone tube intubation (BSTI) performed in 49 patients with nasolacrimal canal obstructions secondary to chronic dacryocystitis. Material and Methods: ETDCR combined with BSTI was applied as a primary procedure in 47 cases, and as a secondary procedure in 2 cases. All patients underwent dacryocystography, and 41 patients underwent radionuclide dacryoscintigraphy before the surgery. Silicone tubes were left in place for about 6.2 months. The patency of the lacrimal passages was controlled with a clinical examination, nasolacrimal canal lavage, and dacryoscintigraphy. Results: Patients were followed up for a mean period of 25.1 months after the removal of the tubes. The epiphora symptom disappeared and a successful drainage could be maintained in 43 out of 49 cases (87.7%). The obstruction rate found in the dacryoscintigraphy performed 15 days after extubation was 22.9%, while it was found to be 14.2% in the nasolacrimal canal lavage. Conclusion: ETDCR combined with BSTI proved to be an effective surgical method in chronic dacryocystitis. The sensitivity and specificity of the postoperative dacryoscintigraphy in determining the surgical success were lower than those of the nasolacrimal canal lavage.

Effects of Merogel coverage on wound healing and ostial patency in endonasal endoscopic dacryocystorhinostomy for primary chronic dacryocystitis

“…Silicone stenting 16,17 and the application of mitomycin C [21][22][23][24][25][26] are the most commonly used methods to maintain ostial patency in EES-DCR surgery. However, limitations have been reported for both of them, including the potential of silicone intubation to induce an [18][19][20] and the inhibitory effect of MMC on fibroblasts, which potentially limits the regeneration of healthy epithelium.…”

“…[1][2][3][4][5][6][7][8] Numerous modifications have been developed to promote ostial patency, ranging from various methods of producing the nasal mucosal and/or lacrimal sac flaps, 2,4,[9][10][11][12] varying the size of the bony ostium, 4,[12][13][14] lacrimal sac incision, 15 to stenting. 16,17 Nevertheless, ostial closure or obstruction still occurs, mostly due to excessive scars/synechia or granulation formation at the ostium. 3,5,6,8,9,[18][19][20] Some authors advocate the use of mitomycin C (MMC) intraoperatively to reduce fibrosis formation, [21][22][23][24][25][26] although granulation tissue has been reported to form around the ostia following MMC application during EES-DCR.…”

Association of rhinostomy shape and surgical outcome after endoscopic endonasal dacryocystorhinostomy

“…Postoperative complications have been reported at rates of 0.6 % to 11 % [5,6]. Numerous modifications have been developed to promote ostial patency, including the creation of nasal mucosal and/or lacrimal sac flaps [7], varying the size of the bony ostium [8], lacrimal sac incision [9], and tube stenting [10]. Recently, some authors have advocated the intraoperative use of mitomycin C or nasal packing to reduce fibrosis formation [11].…”

Resultados e complicações da entubação bicanalicular em dacriocistorrinostomia externa

“…As taxas de sucesso encontradas na literatura relacionadas à cirurgia de DCR são altas variando entre 80% e 98% dos casos operados (15)(16)(17) , semelhante ao resultado obtido neste grupo de pacientes. Apesar disto, muito se tem buscado para o aprimoramento da técnica, seja através de uma abordagem diferente como nas técnicas endoscópica (18)(19)(20) ou transcanalicular (21) , pelo uso de substâncias no intra-operatório como a mitomicina (22) ou o 5-fluouracil (23) , como também através da entubação lacrimal (6)(7) . Algumas indicações adotadas pela maioria dos cirurgiões para a entubação são: saco lacrimal atrófico, obstrução do canalículo comum detectada no pré-operatório, reoperação, retalhos do saco lacrimal-mucosa nasal inadequados e DCR por via endoscópica (24) .…”