Ostium Characteristics and Its Relevance in Successful Outcome Following Endoscopic Dacryocystorhinostomy

Abstract

Study aims to assess the postoperative ostium shrinkage pattern and also attempted to evaluate various ostium parameters and their impact on surgical outcome by using DOS scoring system. Prospective study comprising 44 patients of NLD obstruction with 52 procedures performed during October 2016 to November 2018. Various dimensions of bony neo-ostium were recorded intraoperatively and during 1st, 3rd and 6th month follow up. Degree of ostium shrinkage and its correlation with anatomical and functional success was studied. DCR ostium (DOS) scoring system, comprised of ten various ostium parameters, was used to evaluate postoperative ostium. Intraoperative mean ostium height and width were 13.67 ± 2.76 mm and 7.0 ± 1.94 mm and surface area was 98.33 ± 38.46 mm 2 . Maximum ostium shrinkage (by 66.93%) occurred at 1 month and after which, average size of ostium was quite stable with little change. The anatomical and functional success rate was 94.23% and failure rate was 5.77%. DOS score was ''excellent'' in 40(75.92%), ''good'' in 9(17.31%) and ''poor'' in 3(5.77%) cases. Meticulous evaluation at regular intervals is important for surgeon to understand the characters of ostium during healing and also helps in early detection of pathologies and may facilitate early corrective intervention. We believe that DOS system provides an effective protocol to standardize the ostium evaluation. The ostium parameters with favourable surgical outcome are ostium location anterior to axilla of MT, circular/ oval shape with shallow base, size [ 8 9 5 mm, clearly visualized and dynamic ICO, absence of ostium cicatrization, granulomas, synechiae and other pathologies.

Prospective, randomised clinical trial on the necessity of using a silicone intubarium in the context of a dacryocystorhinostomy (DCR) in patients with postsaccal lacrimal duct stenosis

“…Maximum ostium shrinkage occurs in the rst month after which, average size of ostium is mostly stable with little change. (17) Both objective and subjective factors were collected in this study. For the subjective assessments patients were asked to rate the severity of following symptoms on a scale from zero (no symptoms) to ve (a lot of symptoms): epiphora, recurrent in ammation of the eye, encrustations of the nose and olfactory reduction.…”

The FICI grading for a dacryocystorhinostomy ostium

“…5 The DOS scoring is quite detailed and has been successfully replicated by other Rhinology groups to ascertain the outcomes of endoscopic DCR's. 6 However, it is quite exhaustive and would need a thorough knowledge of endoscopic anatomy and techniques. The current study has attempted to simplify the process by evaluating a large series of 237 ostia on all the 10 parameters of the DOS scoring.…”