Outcome of Endonasal Dacryocystorhinostomy with Nasal and Lacrimal Sac Mucosal Flaps

Abstract

Purpose: In patients with nasolacrimal duct obstruction, the outcomes of surgery were evaluated according to the type or presence of flaps. Methods: In total, 509 eyes were compared retrospectively: 178 eyes in patients treated without flaps, 126 eyes in patients treated using nasal mucosa flaps, and 205 eyes in the patient group using nasal and lacrimal sac mucosal flap were compared retrospectively. We analyzed the factors of success according to the surgical method by comparing granulation and bony ostium obstruction at 1, 3, and 6 months after surgery in each group. Results: At 6 months after surgery, granulation was found in 6 eyes (2.93%) in the nasal and lacrimal sac mucosal flap group, 5 eyes (3.96%) in the nasal mucosal flap group, and 15 eyes (8.42%) in the group treated without flaps. Bony ostium obstruction was found in 3 eyes (1.46%) in the nasal and lacrimal sac mucosal flap group, 4 eyes (2.38%) in the nasal mucosal flap group, and 6 eyes (2.81%) in the group treated without flaps. The anatomical surgical success rate of patients treated with nasal and lacrimal sac mucosal flaps was 95.61%, which was higher than those of patients treated with nasal mucosal flaps (92.86%) and without flaps (88.20%). The functional and anatomical surgical success rate was 94.15% in the group treated with nasal and lacrimal sac mucosal flaps, 88.89% in the group treated with nasal mucosal flaps, and 84.83% in the group treated without flaps. Conclusions: Endonasal dacryocystorhinostomy using the nasal and lacrimal sac mucosal flap is an effective method that minimizes the risk of granulation and bony ostium obstruction.

Endoscopic dacryocystorhinostomy with mucosal anastomosing in chronic dacryocystitis with three categories of ethmoid sinuses

“…In such cases, we recommend incision and enlargement of the anterior part of the sinus before conducting either partial or the entire surgical intervention within the ethmoid sinus. Conventionally, it was essential to form a single nasal sac flap and a single lacrimal sac flap and oppose them during En-DCR [2,[11][12]15,23] . In this study, however, we generated a large C-shaped lacrimal sac flap.…”

“…Moreover, in earlier studies, we demonstrated that supplementary use of Merogel enhances the success of En-DCR surgery for primary chronic dacryocystitis via promotion of early osteium reepithelialization, suppression of fibrotic tissue development at the ostium, and prevention of the lacrimal sac apposition to the nasal mucosa flaps [15,[29][30] . Based on literature, En-DCR has a success rate of 82.2%-95.6% [4,[10][11][12][13][24][25][26] . In this study, En-DCR was performed with a success rate of 93.0%, with complete attenuation of clinical symptoms post-surgery, and with an unobstructed lacrimal system, as evidenced by free-flowing irrigation of the system and nasal cavity.…”

“…One approach is to generate a single nasal flap and a single lacrimal sac flap and appose them during DCR. In another report, the anastomosis of nasal mucosa between lacrimal sac flaps was shown to elevate surgical success, both in primary nasolacrimal obstructions and in revision cases [12][13] . Anatomically, C1 is a perfect candidate for anastomosis of the nasal mucosa to the lacrimal sac flap.…”