Outcomes of 8 × 8 mm osteotomy in powered external dacryocystorhinostomy

Abstract

Purpose: To study the endoscopic ostium characteristics and outcome of 8 × 8 mm osteotomy in external dacryocystorhinostomy (DCR) using the microdrill system. Methods: This prospective interventional pilot study was performed on 40 eyes of 40 patients with primary acquired nasolacrimal duct obstruction (NLDO) from June 2021 to September 2021 in patients undergoing external DCR. An 8 × 8 mm osteotomy was performed using round, cutting burr attached to a microdrill system. Success was defined as patent ostium on lacrimal syringing (anatomical) and a Munk score <3 (functional) at 12 months. Postoperative endoscopic ostium evaluation was done using a modified DCR ostium (DOS) scoring system at 12 months. Results: The mean age of the study participants was 42.41 ± 11.77 years and the male-to-female ratio was 1:4. The mean duration of surgery was 34.15 ± 1.66 minutes and that for osteotomy creation was 2.5 ± 0.69 minutes. The mean intraoperative blood loss was 83.37 ± 11.89 ml. Anatomical and functional success rates were 95% and 85%, respectively. The mean modified DOS score was “excellent” in 34 patients (85%), “good” in 1 patient (2.5%), “fair” in 4 patients (10%), and “poor” in 1 patient (2.5%). Complications included nasal mucosal injury in 10% (4/40) of patients, complete cicatricial closure of ostium in 2.5% (1/40), incomplete cicatricial closure in 10% (4/40), nasal synechiae in 5% (2/40), and canalicular stenosis in 2.5% (1/40). Conclusion: An 8 × 8 mm–sized osteotomy created by powered drill and covered by lacrimal sac–nasal mucosal flap anastomosis in external DCR is an effective technique that has minimal complications and shorter surgical time.

Enhancing Precision: A Visual Guide to Drill-Assisted External Dacryocystorhinostomy Surgery

“…Our experience with drill-assisted DCR aligns with these findings, as we have observed a reduction in the risk of flap injuries and hemorrhage during surgery, along with minimal complications and shorter surgical time. Utilizing assisted external DCR techniques represents a significant advancement in surgical precision, addressing longstanding challenges associated with the procedure [ 3 , 7 ].…”

“…In contrast, conventional DCR may face challenges such as longer surgical duration, higher bleeding rates, less regular osteotomy edges, and a risk of Sump syndrome. Additionally, it may require greater force in cases of a thicker frontal process of the maxilla [ 3 , 7 ].…”

“…Common indications for dacryocystorhinostomy (DCR) include primary acquired nasolacrimal duct obstruction (NLDO), secondary acquired NLDO resulting from factors such as prior midfacial trauma, chronic nasal or sinus inflammation, nasal surgery, neoplasms, or dacryoliths, functional obstruction of outflow due to lacrimal pump weakness or facial nerve palsy, congenital NLDO after failed prior probing or intubation, acute dacryocystitis unresponsive to medical treatment, and chronic dacryocystitis. In the ever-growing landscape of endoscopic techniques driven by aesthetic concerns, external DCR remains the gold standard for addressing NLDO [ 1 - 3 ].…”

“…The conventional mechanical osteotomy, often executed with Kerrison Rongeur or bone punches, poses challenges in cases with thick bones and requires blind fracture induction. This method carries the inherent risk of nasal mucosal damage and subsequent bleeding, potentially compromising flap creation, intraoperative visualization, and overall procedure success [ 1 - 3 ].…”

“…Despite the clinical significance of this technique, the visualization of surgical steps is challenging due to the limited field of operation, and the current literature lacks comprehensive video guidance for drill-assisted external DCR [ 3 - 7 ]. This technical report aims to fill this gap by providing a visual guide to the drill-assisted external DCR technique with silicone intubation.…”