Outcomes of endonasal endoscopic dacryocystorhinostomy after maxillectomy in patients with paranasal sinus and skull base tumors

Abstract

Maxillectomy followed by radiotherapy and/or chemotherapy can result in lacrimal blockage and the need for subsequent dacryocystorhinostomy (DCR). Endonasal endoscopic DCR, as opposed to external DCR, allows better accuracy and leaves no scar. To date no report was published regarding the results of endoscopic DCR in these patients. The current study presents a retrospective review of all patients with paranasal and skull base tumors who developed nasolacrimal duct blockage after ablative maxillectomy with or without radiotherapy and/or chemotherapy and underwent endonasal endoscopic DCR between January 2006 and October 2012 in a tertiary reference medical center. According to our results, ten patients underwent 11 subsequent endonasal endoscopic DCR. There were 6 men and 4 women with a median age of 55 years (range, 19-81 years); four suffered from benign tumors and six had malignant tumors. All underwent maxillectomy. Six received high-dose radiotherapy. Time interval between primary ablative surgery and endonasal endoscopic DCR was 18 months (range, 7-118 months). Silicone stents were removed after median period of 11 weeks (range, 1-57 weeks). Nine out of ten patients experienced symptomatic improvement following one endonasal endoscopic DCR. One patient had recurrent epiphora and underwent a successful endonasal endoscopic revision DCR. In conclusion, endonasal endoscopic DCR in patients with paranasal and skull base tumors, who previously underwent maxillectomy, is generally successful and not associated with a high rate of complications or failure. Moreover, our findings may suggest that silicone stents can be removed shortly after the operation with high success rate.

Evidence-based review of surgical practices in endoscopic endonasal dacryocystorhinostomy for primary acquired nasolacrimal duct obstruction and other new indications

“…The first report of EN-DCR for the treatment of acquired nasolacrimal duct obstruction in this patient population was a small retrospective case review [14]. These interventions may result in nasolacrimal duct obstruction.…”

Medical Malpractice Trends in Dacryocystorhinostomy and Orbital Decompression

“…Although an external approach is used in the majority of orbital decompression and DCR surgeries, endoscopic orbital surgery has gained popularity over the past decade for its minimally invasive nature. 1,2 The surgical complications rates of these procedures are relatively low and have been reported previously. 1 However, the pattern of malpractice lawsuits related to these surgeries is unknown and unreported.…”

“…Endoscopic orbital surgery has increasingly gained popularity over the past decade. 1,2 As such, it is critical to understand the medicolegal considerations surrounding popular endoscopic orbital procedures, especially those considered to comprise foundational training for surgical subspecialists; for sinus surgeons considering expanded endoscopic orbital surgery, such procedures include orbital decompression and dacryocystorhinostomy.…”

The multidisciplinary approach to the diagnostics and surgical treatment of the lacrimal passages

“…Abu-Ghanem и соавт. [26] описывают 8 случаев стойкой послеоперационной эпифоры, явившейся осложнением эндоскопической синус-хирургии. Авторы отмечают высокую успешность функциональной хирургии, что служит причиной все большей популярности этой техники и констатируют, что рост числа подобных операций соответственно приведет к росту числа осложнений, в том числе со стороны НК.…”