Prospective randomised controlled study comparing endonasal dacrocystorhinostomy conducted with and without potassium titanyl phosphate (KTP) laser for patients demonstrated to have nasolacrimal duct obstruction

AbstractBackground:Rhinostomy patency is a problem in all forms of dacryocystorhinostomy. Laser-assisted procedures are potentially fast and result in excellent haemostasis. However, they may induce more fibroblastic activity, resulting in excessive scarring and stenosis of the rhinostomy, compared with non-laser dissection.Objectives:The objective of this study was to compare subjective outcomes following dacryocystorhinostomy conducted with endoscopic endonasal laser and with endonasal surgical techniques.Study design:Prospective, randomised, controlled trial comparing potassium titanyl phosphate endonasal laser dissection with endonasal surgical techniques, for dacryocystorhinostomy to treat epiphora due to primary, acquired nasolacrimal duct obstruction.Participants:One hundred and twenty-six adult patients with chronic epiphora due to primary, acquired nasolacrimal sac or duct obstruction.Interventions:Interventions comprised endonasal dacryocystorhinostomy, performed using potassium titanyl phosphate laser or surgical dissection, in order to open the lacrimal sac into the nasal cavity.Outcome measures:These were: symptom score and symptom relief of epiphora (at three and 12 months post-procedure); duration and ease of procedure; and duration of hospital stay.Results:Sixty patients underwent endonasal laser dacryocystorhinostomy and 66 underwent endonasal surgical dacryocystorhinostomy. Symptomatic success was 82 per cent at three months and 68 per cent at 12 months in the laser group, and 76 per cent at three months and 74 per cent at 12 months in the surgical group. A two-point reduction in the symptom score was associated with symptomatic success at three and 12 months. Eight patients randomised to the laser group required additional instrumentation in order to remove thick bone over the lacrimal sac.Conclusions:At three months, endonasal laser dacryocystorhinostomy had better results than endonasal surgical dacryocystorhinostomy. However, at 12 months, the surgical procedure had better results than the laser procedure. There was no statistically significant difference between the two groups at three or 12 months with regard to symptomatic outcome. The ease of procedure (on a scale of zero to 10) was 4.5 for the laser procedure and 4.1 for the surgical procedure. The average times for the procedures were 25 minutes in the laser group and 20 minutes in the surgical group. No statistical difference was found when comparing: symptom score improvement for local anaesthetic vs general anaesthetic; ages over and under 70 years; laterality; or operating surgeon. Change in the symptom score was a useful indicator of symptomatic success.

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Nasolacrimal Duct Obstruction and Frequency of Agger Nasi Cell and other Anatomical Field Variations: A Controlled Study in Northern Iran

ACTA MEDICA IRANICA ◽

10.18502/acta.v59i4.6218 ◽

2021 ◽

Author(s):

Hassan Behboudi ◽

Abtin Heirat ◽

Hengameh Behboudi ◽

Maryam Akbari ◽

Naghi Ramezani ◽

...

Keyword(s):

Complex Disease ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Controlled Study ◽

Control Group ◽

Concha Bullosa ◽

Northern Iran ◽

Duct Obstruction ◽

Radiologic Findings ◽

Computed Tomography Scanning

In this study, we aimed to find the frequency of agger nasi cells (ANC) and their correlation with other anatomical anomalies in dacryocystorhinostomy (DCR) candidates, compared with a control group. The study was conducted on 42 patients with nasolacrimal duct obstruction who underwent DCR surgery. Also, 80 C.T. of healthy sex- and age-matched subjects were selected as the control group. Paranasal sinuses computed tomography scanning was performed preoperatively, and abnormalities including ANC, concha bullosa, osteomeatal complex disease (OMC), nasal septum deviation, and polyposis were investigated and registered. Radiologic findings showed ANC presence in 83.3% of cases, and frequency of concha bullosa was 23.8%, and OMC disease, septal deviation, and nasal polyposis recorded as 11.9%, 85.7%, and 14.3%, respectively. In the control group, ANC was found in 52 subjects (65%), and the difference was statistically significant (P=0.036). There was no significant correlation between the presence of ANC and the coexistence of other mentioned anatomical changes as attributing factors for NLD obstruction. The frequency of ANC was much higher in patients with NLD obstruction compared with the control group, but its association with other anomalies was non-significant.

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