Increased Concomitant Nasal Procedure Frequency in Bilateral Endoscopic Dacryocystorhinostomy

Abstract

The etiology of primary nasolacrimal duct obstruction (NLDO) is unknown, and the disease may exist bilaterally in a small number of patients. Dacryocystorhinostomy (DCR) surgery is the recommended treatment for these patients, but concomitant nasal pathologies are believed to be related to decreased surgical success. The authors aim to assess the concomitant required nasal surgical procedure frequency for endoscopic surgical access retrospectively in bilateral and unilateral NLDO patients. Twenty-eight patients who underwent bilateral endoscopic DCR simultaneously and 30 patients who underwent unilateral endoscopic DCR were enrolled in this retrospective study. Required concomitant nasal procedure frequency was recorded. In the bilaterally applied DCR group, septoplasty, partial midline turbinectomy, and inferior nasal concha submucosal resection rates were 16 (57.1%), 5 (17.8%), and 3 (10.7%) patients, respectively. Septoplasty and concha bullosa resection were performed simultaneously in 2 patients. Also, uncinectomy was performed with septoplasty in 1 patient. The concomitant nasal surgery rate was 22 of 28 patients (78.6%). On the other hand, in the unilaterally applied DCR group, septoplasty, partial midline turbinectomy, and inferior nasal concha submucosal resection rates were 5 (16.7%), 1 (3.3%), and 2 (6.7%) patients, respectively. Both septoplasty and concha bullosa resection were done in 1 patient. Uncinectomy was performed on 1 (3.3%) patient. A concomitant surgery rate was observed in 8 of 30 patients (26.7%). Nasal pathology, which requires surgical intervention, is seen much more frequently in bilateral than in unilateral NLDO patients.

Bilateral Simultaneous Endoscopic Dacryocystorhinostomy: Outcome and Impact on the Quality of Life of the Patients

“…Another limitation of the present study is the small sample size attributed to the already low incidence of bilateral disease, which is also seen as a limitation in the recent studies on bilateral DCR. 8 9 30 Therefore, we believe that publishing this experience is necessary to contribute to the body of the work on this subject. Additionally, the current study uniquely addresses the quality of life as well as the stratification in this subset of patients.…”

Adjunctive techniques to dacryocystorhinostomy: an evidence‐based review with recommendations

“…Rates of concurrent septoplasty vary, ranging between 12% and 47% 36–39 . When evaluating bilateral DCR vs unilateral DCR specifically, septoplasty was performed with greater frequency (57% vs 17%) 40 …”

“…[36][37][38][39] When evaluating bilateral DCR vs unilateral DCR specifically, septoplasty was performed with greater frequency (57% vs 17%). 40 This concept is further supported by multiple studies showing a statistically significant higher rate of concurrent nasal procedures for revision DCR cases, often times where the primary DCR was performed through an external approach. 32,34,41 Chan et al 42 reported that over a 5-year period, 67% of the failures of the external DCRs in their series were attributed to the presence of a nasal septal deviation, with a 100% success rate in these cases following revision DCR surgery that also included a septoplasty.…”

The importance of endoscopy in lacrimal surgery

“…Simultaneous endoscopic DCR has medical and economic benefits, reduced morbidity, improved quality of life and prevents the stress of second surgery. General anesthesia is preferable when doing bilateral simultaneous endoscopic DCR [25].…”

“…Many nasal conditions such as deviated nasal septum, concha bullosa, middle/inferior turbinate hypertrophy and nasal polyposis are thought to limit surgical access and influence the outcomes of En-DCR. Previously published literature shows varying rates of simultaneous endoscopic procedures ranging from 14% to as high as 78% [11,25,31,32]. Septoplasty is the most common adjunctive procedure required during endoscopic DCR [11].…”