Possibility of Pseudo-Obstruction in Lacrimal Canalicular Obstruction Diagnosed with Dacryocystography

ORL ◽  
2021 ◽  
pp. 1-5
Author(s):  
Woo Sub Shim ◽  
Min Jai Cho ◽  
Young Kang ◽  
Seok Hee Lee ◽  
Joo-Yeon Lee ◽  
...  
Keyword(s):  
Success Rate ◽  
Surgical Outcomes ◽  
Demographic Data ◽  
Drainage System ◽  
Tertiary Hospital ◽  
Symptom Improvement ◽  
Diagnostic Efficacy ◽  
Canalicular Obstruction ◽  
Endoscopic Dcr ◽  
Lacrimal Drainage

<b><i>Introduction:</i></b> Endoscopic dacryocystorhinostomy (DCR) is the treatment of choice for patients with lacrimal drainage system obstruction. Dacryocystography (DCG) is one of the most common preoperative studies and considered as a useful test demonstrating the anatomy of lacrimal drainage systems. <b><i>Objective:</i></b> This study was designed to evaluate the diagnostic efficacy of DCG for canalicular obstruction and to compare surgical outcomes between true-obstruction versus pseudo-obstruction diagnosed with DCG. <b><i>Methods:</i></b> A retrospective study was performed on 45 consecutive patients with lacrimal canalicular obstruction who had underwent endoscopic DCR with silicone tube insertion from January 2009 to December 2014 at a single tertiary hospital. A review of medical records included demographic data, preoperative symptoms and signs, results of intraoperative canalicular probing, and surgical outcomes including the postoperative symptom improvement and endoscopic finding. <b><i>Results:</i></b> Of 45 patients, 34 patients (75.6%) had true-canalicular obstructions and 11 patients (24.4%) had pseudo-canalicular obstructions. The success rate of endoscopic DCR was 50% (17 of 34) in cases with true-canalicular obstruction while 90.9% (10 of 11) in pseudo-canalicular obstruction (<i>p</i> value &#x3c;0.05). No intraoperative or postoperative complications including sinusitis or synechia were found. <b><i>Conclusions:</i></b> About a quarter of lacrimal canalicular obstruction cases diagnosed with DCG seem to be pseudo-obstruction. The success rate of endoscopic DCR in pseudo-canalicular obstruction is similar to that of saccal and nasolacrimal ductal obstruction.

Topical Application of Mitomycin-C in Endoscopic Dacryocystorhinostomy

2000 ◽  
Vol 14 (3) ◽  
pp. 205-208 ◽  
Author(s):  
Yookyung K. Selig ◽  
Brian S. Biesman ◽  
Elie E. Rebeiz
Keyword(s):  
Success Rate ◽  
Mitomycin C ◽  
Topical Application ◽  
Drainage System ◽  
Endoscopic Dacryocystorhinostomy ◽  
Small Series ◽  
Endoscopic Dcr ◽  
Intraoperative Adjuncts ◽  
Lacrimal Drainage

Endoscopic dacryocystorhinostomy (DCR) is a well-established alternative to external DCR for treatment of obstruction of the lacrimal pathway and has a success rate of up to 95% in primary cases. Despite the benefits of using an endoscopic approach, including enhanced intranasal access to the lacrimal drainage system, there still exists a significant failure rate, particularly in revision procedures. As these failures are mainly due to obstructive postoperative adhesions, intraoperative adjuncts that prevent or minimize scarring should enhance the success rate. Endoscopic DCR was performed with intraoperative topical application of mitomycin-C, an antimetabolite often used in ophthalmologic procedures to reduce scarring and formation of adhesions following surgery. The procedure was successful in 7 of 8 instances, with a follow-up of 3 to 27 months. In one procedure, obstruction recurred 10 weeks after surgery. We feel that the results of this small series are encouraging and that further studies are warranted to determine the effectiveness of mitomycin-C as an adjunct to endoscopic DCR.

The effect of lacrimal drainage abnormality on the surgical outcomes of congenital lacrimal fistula and vice versa

2021 ◽  
pp. 112067212199472
Author(s):  
Yong Min Choi ◽  
Yeonji Jang ◽  
Namju Kim ◽  
Ho-Kyung Choung ◽  
Sang In Khwarg
Keyword(s):  
Surgical Outcomes ◽  
Surgical Outcome ◽  
Drainage System ◽  
Mutual Effect ◽  
Symptom Improvement ◽  
Lacrimal Drainage System ◽  
Surgical Methods ◽  
The Mean ◽  
Lacrimal Fistula ◽  
Lacrimal Drainage

Purpose: To evaluate the various surgical modalities of congenital lacrimal fistula and assess the mutual effect of lacrimal fistula and lacrimal drainage abnormality on the individual surgical outcomes. Methods: In this retrospective cohort and case-control study, 74 eyes from 63 patients with lacrimal fistula who underwent surgical management between 2000 and 2015 at three medical centers were enrolled. The data collected included sex, age, preoperative symptoms, presence of concurrent lacrimal drainage abnormality, surgical methods, and surgical outcomes. The main outcome measures were treatment outcomes based on lacrimal drainage patency and symptom improvement, surgical outcome of fistulectomy according to the presence of lacrimal drainage abnormality, and surgical outcome of lacrimal drainage abnormality according to the presence of fistula. Results: The mean age at the time of surgery was 9.2 (SD, ±8.8) years and the mean follow-up duration was 14.4 (SD, ±19.5) months. All eyes (37/37) with fistula without lacrimal drainage abnormality demonstrated surgical success after simple fistulectomy. Patients with concurrent lacrimal drainage abnormalities showed more frequent surgical failure than those with fistula alone ( p = 0.009). However, the presence of fistula did not affect the outcomes of surgery for lacrimal drainage abnormality ( p = 0.179). Conclusion: Simple fistulectomy is sufficient for sole asymptomatic or pauci-symptomatic lacrimal fistula. Symptomatic fistula as well as those accompanied with lacrimal drainage abnormality underwent fistulectomy and lacrimal drainage system surgery. Patients with accompanying lacrimal drainage system abnormalities showed less favorable outcomes. Meticulous preoperative examination of the lacrimal drainage system is critical for surgical planning and prognosis prediction.

Surgical results and factors affecting outcome in patients with fat-graft myringoplasty

2021 ◽  
pp. 014556132110632
Author(s):  
Hong Chan Kim ◽  
Kyeong Suk Park ◽  
Hyung Chae Yang ◽  
Chul Ho Jang
Keyword(s):  
Success Rate ◽  
Tympanic Membrane ◽  
Surgical Outcomes ◽  
Underlying Disease ◽  
Tertiary Hospital ◽  
Tympanic Membrane Perforation ◽  
Fat Graft ◽  
Ear Surgery ◽  
Closure Rate ◽  
Diabetes Status

Objectives: We evaluated the closure rate after fat-graft myringoplasty (FGM) of perforations differing in size and location. We explored whether patient’s factors and the FGM surgical technique influenced surgical outcomes. Methods: We retrospectively studied patients with tympanic membrane perforations who underwent FGM from March 2015 to March 2019. All procedures were performed by a single senior surgeon at our tertiary hospital. The patients who followed-up for at least 6 months after surgery were enrolled. We recorded hypertension and diabetes status, age, any prior ear surgery, any calcific plaques adjacent to the perforation, and perforation size and location. Results: A total of 150 patients were enrolled. Our success rate of FGM was 90%. Hypertension, diabetes, prior ear surgery history, and eardrum calcific plaques did not affect the surgical outcomes. There was no statistical difference in the surgical success rate according to the size (< 50%) or location of perforation. The closure rate was 97.2% in patients aged 1660 and 87.5% in patients aged > 60, respectively. However, FGM was successful in only two of six children (33.3%) aged ≤ 15 years, thus significantly less than in the other groups. Conclusion: FGM is a fast, safe, and efficient method for repairing tympanic membrane perforation. The surgical outcome is not significantly affected by underlying disease, perforation size or location, or by the condition of the tympanic membrane or older age. However, it may be poor in children with dysfunctional Eustachian tube.

Revision Dacryocystorhinostomy: A Comparison of Endoscopic and External Techniques

2005 ◽  
Vol 19 (3) ◽  
pp. 322-325 ◽  
Author(s):  
Angelo Tsirbas ◽  
Garry Davis ◽  
Peter J. Wormald
Keyword(s):  
Success Rate ◽  
Complete Relief ◽  
Fisher Exact Test ◽  
Success Rates ◽  
Exact Test ◽  
Endoscopic Techniques ◽  
Canalicular Obstruction ◽  
Endoscopic Dcr ◽  
External Dcr

Background Success rates for revision dacryocystorhinostomy (DCR) are lower than primary DCR. Scarring of the sac may limit the ability of the surgeon to achieve good nasal and lacrimal mucosa apposition. This study evaluates the comparative success rates of the external and endoscopic techniques for revision DCR. Methods Seventeen consecutive revision endoscopic DCRs (average age, 60.9 years) and 13 revision external DCRs (average age, 65.1years) performed from January 1999 to December 2000 performed by separate surgeons were entered into the study. Patients with functional nasolacrimal and canalicular obstruction were excluded. The average follow-up was 11.1 months for the endoscopic DCR group and 10 months for the external DCR group. Results A successful DCR required complete relief of symptoms and an endoscopically determined anatomic patency of the nasolacrimal system. Revision endoscopic DCR surgery was successful in 76.5% of cases (13 of 17 cases) and external DCR surgery was successful in 84.6% (11 of 13 cases). This difference was not statistically significant. (p = 0.64, Fisher exact test with a two-tailed probability). Conclusion Revision endoscopic DCR has a success rate of 76.5%, which compares favorably with that of the revision external DCR (84.6%).

scholarly journals Comparative Study Of External And Endoscopic Endonasal Dacryocystorhinostomy For The Treatment Of Chronic Dacryocystitis

2012 ◽  
Vol 7 (2) ◽  
pp. 15-17 ◽  
Author(s):  
MKH Khan ◽  
MA Hossain ◽  
MJ Hossain ◽  
A Al-Masud ◽  
MZ Rahman
Keyword(s):  
Endoscopic Surgery ◽  
Surgical Outcome ◽  
Drainage System ◽  
Endoscopic Endonasal ◽  
Lacrimal Drainage System ◽  
Chronic Dacryocystitis ◽  
Endonasal Dcr ◽  
Endoscopic Dcr ◽  
External Dcr ◽  
Lacrimal Drainage

Introduction: Dacryocystorhinostomy (DCR) is the treatment of choice for Chronic Dacryocystitis. Although external DCR is still regarded as gold standard for acquired naso-lacrimal duct obstruction, endoscopic DCR is evolving as an equally effective alternative in the recent past. Objective: The study was carried out to compare the surgical outcome of external DCR and endoscopic endonasal DCR for the treatment of Chronic Dacryocystitis. Method: This observational study was carried out in the Department of Ophthalmology, Combined Military Hospital, Dhaka from November 2008 to May 2009. A total of 30 consecutive patients were selected for DCR surgery. Among those 15 patients underwent endoscopic endonasal DCR and 15 under went patients external DCR. Data regarding ocular examination, lacrimal drainage system, per-operative and postoperative complications and ultimate surgical outcome were collected and analyzed. Surgical success was defined by patient's resolution of symptoms with patency of lacrimal drainage system. Failure was defined as no symptomatic reduction in epiphora and/or inability to irrigate the lacrimal drainage system postoperatively. Results: Mean age of the patients was 35.0±11.3 years. Fifty three percent of the study subject was male and 43% of the study subject was female. Accumulated result showed that both surgical approaches had almost similar success rate (endoscopic DCR 73.3% versus external DCR 80%; p=0.666). Complication rate was low and no appreciable difference in complication was marked in both types of surgery. Twenty percent in endoscopic DCR group and 13.3% in external DCR group had moderate bleeding. Two patients (13.3%) of endoscopic surgery required septoplasty. All the complications were managed by conservative treatment. Post operative complication particularly nonpatent lacrimal drainage system occurred to 26.7% of endoscopic group and 20% of those with external DCR surgery. Silicon tube was in situ up to 3 months in all the cases. Ultimate failure occurred in 26.7% for endoscopic DCR and 20% for external DCR. Conclusions: Surgical outcome of both endoscopic and external DCR for Chronic Dacryocystitis was quite satisfactory. Overall complication rate was low. Endoscopic surgery might have an advantage of not having any external scar but it requires high equipment cost and long learning curve. DOI: http://dx.doi.org/10.3329/jafmc.v7i2.10389 JAFMC 2011; 7(2): 15-17

scholarly journals Pulled versus Pushed Monocanalicular Silicone Intubation in Adults with Lacrimal Drainage System Stenosis: A Comparative Case Series

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Abolfazl Kasaee ◽  
Bahram Eshraghi ◽  
Kambiz Ameli ◽  
Hossein Ghahvehchian ◽  
Mansooreh Jamshidian-Tehrani ◽  
...  
Keyword(s):  
Success Rate ◽  
Drainage System ◽  
Case Series ◽  
Nasolacrimal Duct ◽  
Lacrimal Drainage System ◽  
Tube Removal ◽  
Silicone Intubation ◽  
Canalicular Stenosis ◽  
Grade 3 ◽  
Lacrimal Drainage

Purpose. To compare the success rate and complications of pulled versus pushed monocanalicular intubation in adults with incomplete lacrimal drainage system obstruction (lacrimal drainage system stenosis). Methods. Patients with lacrimal drainage system stenosis (Munk grade ≥3), including both nasolacrimal duct (NLD) stenosis and common canalicular stenosis, were recruited in this prospective comparative case series. Patients underwent probing and either Monoka (51 eyes) or Masterka (48 eyes) intubation under general or local anesthesia. Tubes were removed 4–14 weeks after the procedure. Six months after tube removal, Munk grades 0 and 1 were defined as a complete success, Munk grade 2 was defined as a partial success, and Munk grade ≥3 was defined as failure. All complications were recorded. Results. Ninety-nine eyes from 89 patients with lacrimal drainage system stenosis who underwent either Monoka (51 eyes) or Masterka (48 eyes) intubation were included. The mean (SD) age of the patients was 55.4 (12) years in the Monoka group and 53.5 (12.9) in the Masterka group. Groups were matched on demographics. Masterka intubation could not be performed in one eye. Complete and partial successes were observed in 52.9% (27/51) and 17.6% (9/51) of eyes in the Monoka group and 42.6% (20/47) and 12.8% (6/47) of eyes in the Masterka group, respectively ( p = 0.29 ). There was a trend toward a higher total success rate in patients with NLD stenosis treated with Monoka 66.7% (26/39) than Masterka 45.5% (15/33) intubation ( p = 0.07 ). This trend also existed in patients with common canalicular stenosis (83.3% (10/12) vs. 76.6% (11/14), p = 0.75 ). Age, sex, bilateral involvement, and duration of intubation did not have a significant impact on the success rate. Early tube loss, slit puncta, and temporary superficial punctate keratopathy were observed complications. Conclusion. Intubation with the pulled monocanalicular silicone tube was associated with a slightly but not significantly higher success rate in adults with lacrimal drainage system stenosis. Patients with NLD stenosis may achieve better results with pulled silicone tubes.

Silicone Intubation as an Alternative to Dacryocystorhinostomy for Nasolacrimal Drainage Obstruction in Adults

1993 ◽  
Vol 3 (2) ◽  
pp. 71-76 ◽  
Author(s):  
K. Psilas ◽  
V. Eftaxias ◽  
J. Kastanioudakis ◽  
C. Kalogeropoulos
Keyword(s):  
Success Rate ◽  
Drainage System ◽  
Nasolacrimal Duct ◽  
Silicone Tube ◽  
Duct Obstruction ◽  
Silicone Tubing ◽  
Chronic Dacryocystitis ◽  
Silicone Intubation ◽  
Lacrimal Drainage

Silicone tubing was used to repair the patency of the nasolacrimal drainage system in 115 patients (four bilaterally) with chronic nasolacrimal duct obstruction. The patients were over 20 years old and 16 were men and 99 women; 46% presented an uncomplicated obstruction with epiphora and 54% presented additional signs of chronic dacryocystitis. We used the technique of Quickert and Dryden with modifications. The silicone tube remained for a mean of 5.5 months (± 2.5 SD). After removal of the tube the follow-up ranged from 6 to 42 months (mean ± SD: 16 ± 9). Patency was maintained in 89% of cases with uncomplicated obstruction and in 69% of those with chronic dacryocystitis (total success rate 78%). We can therefore recommend silicone intubation of the lacrimal drainage system as an alternative to dacryocystorhinostomy (DCR), in adults with obstruction of the nasolacrimal duct. In addition, unlike DCR this technique is bloodless and the operation takes less time.

scholarly journals Pattern of symptom improvement following endoscopic sinus surgery for chronic rhinosinusitis

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Salma S. Al Sharhan ◽  
Mohammed H. Al Bar ◽  
Shahad Y. Assiri ◽  
Assayl R. AlOtiabi ◽  
Deemah M. Bin-Nooh ◽  
...  
Keyword(s):  
Surgical Outcomes ◽  
Endoscopic Sinus Surgery ◽  
T Test ◽  
Sinus Surgery ◽  
Symptom Improvement ◽  
P Value ◽  
Psychological Dysfunction ◽  
Significant Difference ◽  
The Mean ◽  
Snot 22

Abstract Background Chronic rhinosinusitis (CRS) is a common inflammation of the nose and the paranasal sinuses. Intractable CRS cases are generally treated with endoscopic sinus surgery (ESS). Although the effect of ESS on CRS symptoms has been studied, the pattern of symptom improvement after ESS for CRS is yet to be investigated. The aim of this study was to determine the magnitude and sequence of symptom improvement after ESS for CRS, and to assess the possible preoperative factors that predict surgical outcomes in CRS patients. Methods This was a longitudinal prospective study of 68 patients who had CRS (with or without nasal polyps). The patients underwent ESS at King Fahd Hospital of the University, Al Khobar, Saudi Arabia. The Sino-nasal Outcome Test-22 (SNOT-22) questionnaire was used for assessment at four time points during the study: pre-ESS, 1-week post-ESS, 4 weeks post-ESS, and 6 months post-ESS. Results The difference between the mean scores recorded for the five SNOT-22 domains pre-ESS and 6 months post-ESS were as follows: rhinologic symptoms (t-test = 7.22, p-value =  < 0.001); extra-nasal rhinologic symptoms (t-test = 4.87, p-value =  < 0.001); ear/facial symptoms (t-test = 6.34, p-value =  < 0.001); psychological dysfunction (t-test = 1.99, p-value = 0.049); and sleep dysfunction (t-test = 5.58, p-value =  < 0.001). There was a significant difference between the mean scores recorded for the five domains pre-ESS and 6 months post-ESS. Rhinologic symptoms had the largest effect size (d = 1.12), whereas psychological dysfunction had the least effect size (d = 0.24). The only statistically significant difference in the SNOT-22 mean scores recorded 4 weeks post-ESS was observed between allergic and non-allergic patients (t = − 2.16, df = 66, p = 0.035). Conclusion Understanding the pattern of symptom improvement following ESS for CRS will facilitate patient counselling and aid the optimization of the current treatment protocols to maximize surgical outcomes and quality of life. Level of evidence Prospective observational.

Prevalence of Hyponatremia and Its Associated Morbimortality in Hospitalized Patients Receiving Parenteral Nutrition

2017 ◽  
Vol 71 (1-2) ◽  
pp. 1-7 ◽  
Author(s):  
Emilia Gómez-Hoyos ◽  
Martín Cuesta ◽  
Nayade Del Prado-González ◽  
Pilar Matía ◽  
Natalia Pérez-Ferre ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Mortality Rate ◽  
Parenteral Nutrition ◽  
Demographic Data ◽  
Tertiary Hospital ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Control Subjects ◽  
Comorbidity Index

Background: The objective of the study was to determine the prevalence of hyponatremia (HN) and its associated morbimortality in hospitalized patients receiving parenteral nutrition (PN). Methods: A retrospective study including 222 patients receiving total PN (parenteral nutrition group [PNG]) over a 7-month period in a tertiary hospital and 176 matched to 179 control subjects without PN (control subjects group [CSG]). Demographic data, Charlson Comorbidity Index (CCI), date of HN detection-(serum sodium or SNa <135 mmol/L)-intrahospital mortality, and hospital length-of-stay (LOS) were registered. In the PNG, body mass index (BMI) and SNa before, during, and after PN were recorded. Results: HN was more prevalent in the PNG: 52.8 vs. 35.8% (p = 0.001), and independent of age, gender, or CCI (OR 1.8 [95% CI 1.1-2.8], p = 0.006). In patients on PN, sustained HN (75% of all intraindividual SNa <135 mmol/L) was associated with a higher mortality rate independent of age, gender, CCI, or BMI (OR 7.38 [95% CI 1.07-50.8], p = 0.042). The absence of HN in PN patients was associated with a shorter hospital LOS (<30 days) and was independent of other comorbidities (OR 3.89 [95% CI 2.11-7.18], p = 0.001). Conclusions: HN is more prevalent in patients on PN. Sustained HN is associated with a higher intrahospital mortality rate. Absence of HN is associated with a shorter hospital LOS.

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