Study of patient outcome in endoscopic dacrocystorhinosomy using a microdebrider in chronic dacryocystitis patients

Background: Endoscopic dacryocystorhinostomy (DCR) has become accepted as a suitable treatment for patients with chronic dacryocystitis. In this study authors did endoscopic dacrocystorhinosomy using a microdebrider, which is a recent advancement tool being used successfully in other endoscopic sinus surgeries also. Limited studies are available as of now on this topic.Methods: A total number of 33 patients (with 40 affected eyes) presenting with complains of epiphora having nasolacrimal duct obstruction were selected. They underwent an endoscopic DCR in which dissection of some nasal mucosa and widening of bony ostium was done using a microdebrider. Silicone stent was passed into the nasolacrimal duct through both punctum. Patient outcome was assessed by using both objective (endoscopy and dye test) and subjective (improved symptoms) criteria. Standard follow up time for clinical course was kept 3 months with weekly visits.Results: Patients which got relief from epiphora in 37 eyes (92.5% cases) had no obstruction on endoscopy and positive dye test. Rest (7.5 % cases) had presence of granulation tissue at rhinostoma site and negative dye test, which was cited as the cause of failure.Conclusions: The use of microdebrider is potentially beneficial in endoscopic endonasal dacryocystorhinostomy. By using such an instrument, the minimal amount of tissue damage occurs, a large fistula is formed, and the recurrence due to the formation of adhesions/synechiae/granulations is prevented/reduced thus reducing the time of surgery, complications and failure rate.

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Endoscopic DCR with and without prolene stent in rural area: a prospective randomized study

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20182718 ◽

2018 ◽

Vol 4 (4) ◽

pp. 1081

Author(s):

Abhay Kumar ◽

Prateek Kumar Porwal ◽

Kailash Prasad Dubey ◽

Harshita Singh

Keyword(s):

Randomized Study ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Successful Outcome ◽

Endoscopic Endonasal ◽

Female Ratio ◽

Duct Obstruction ◽

Chronic Dacryocystitis ◽

Endonasal Dcr ◽

Endoscopic Dcr

Background: The objective of the study was to compare the results of endoscopic DCR with and without prolene stenting and to assess subjective and anatomical success in patients undergoing prolene stenting.Methods: The surgical outcomes of endoscopic endonasal DCR was compared in 100 patients of chronic dacryocystitis with nasolacrimal duct obstruction from June 2013 to May 2018. The successful outcome of surgery was defined by subjective improvement of symptoms and anatomical patency of the neo-ostium on syringing by nasal endoscopy. Results: In our study females were predominant in both groups with around 60% being females in group with stenting and 64% in group without stenting. Male to female ratio was 1:1.5 and 1:1.77 in group with stenting and without stenting. The symptomatic success rate of the surgery at the end of 3 months was 92% in group without stenting and 88% in group with stenting. There was no statistical difference in the results of two groups.Conclusions: We recommend that stenting is not routinely required for endoscopic DCR surgeries. A selective stenting approach may be advocated using prolene 3-0, using stenting for specific indications. With proper surgical technique and good follow up, endoscopic DCR without stenting is treatment of choice for chronic nasolacrimal duct obstruction.

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A New Modification in Endoscopic Endonasal Dacryocystorhi̇nostomy Scopy-Guided Approach

10.21203/rs.3.rs-307225/v1 ◽

2021 ◽

Author(s):

Akalın İrfan ◽

Ahmet Kalkışım ◽

Hasan Gündoğdu

Keyword(s):

Surgical Intervention ◽

Nasolacrimal Duct ◽

Silicone Tube ◽

Endoscopic Endonasal ◽

New Approach ◽

Surgical Success ◽

Endoscopic Dacryocystorhinostomy ◽

Significant Difference ◽

Endoscopic Dcr ◽

Anatomical Success

Abstract PurposeTo compare and assess classic endoscopic dacryocystorhinostomy (cEDCR) and scopy-guided endoscopic dacryocystorhinostomy (sEDCR) which is a new approach we developed in cases of primary nasolacrimal duct obstruction (PNLDO).MethodsFifty eyes (7 in both eyes) of 43 patients who applied with epiphora and underwent endoscopic DCR and silicone tube implantation between 2015 and 2019 were prospectively studied. cEDCR was performed on 26 of 50 eyes, and sEDCR was performed on 24 of 50 eyes. In sEDCR application, 5 cc non-ionizing opaque material was injected after punctum dilatation, lateral oblique radiographs were taken from the obstructed side with C-arm scope, and the size and location of the lacrimal sac were made visible. Thence, the most appropriate part of the passage was visualized, and surgical intervention was made through this point. Patients were followed in day 1, week 1, 3rd and 6rd mounth. Functional success was assessed according to Munk scoring, and anatomic success was assessed with nasolacrimal lavage. Two groups were compared according to surgical success, time, and complications.ResultsMean age of the cases were 47.85 (±11.8) in the cEDCR group and 54.29 (±16.23) in the sEDCR group. Female and male gender distribution was 21 (80.8%) - 5 (19.2%) for cEDCR and 15 (62.5%) - 8 (37.5%) for sEDCR, respectively. Functional success was spotted as 92.3% in the cEDCR group and 95.8% in the sEDCR group (p:1.0); anatomical success was spotted as 88.5% in the cEDCR group, and 95.8% in the sEDCR group (p:0,611). There was no significant difference between two groups. Mean surgery time was 43 minutes in the cEDCR group and 48 minutes in the EDCR group. Complications were minor and rare (p >0.05). ConclusionAs we are aware of that, our study is the first in literature in which scopy is used in endoscopic DCR. In our study, the sEDCR approach is assessed as a useful modification which improves success and facilitates surgery.

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Role of Silicone Stenting in Endoscopic Dacryocystorhinostomy: A Comparative Study

International Journal of Advanced and Integrated Medical Sciences ◽

10.5005/jp-journals-10050-0002 ◽

2016 ◽

Vol 1 (1) ◽

pp. 4-6 ◽

Cited By ~ 2

Author(s):

Shahzad Ahmad ◽

Bhawana Pant

Keyword(s):

Comparative Study ◽

Nasolacrimal Duct ◽

Endoscopic Dacryocystorhinostomy ◽

Medical College ◽

Randomized Design ◽

Silicone Stent ◽

Foreign Body Reactions ◽

Endoscopic Dcr ◽

The Cost

ABSTRACT Objective To evaluate the role of using silicone stent in endoscopic dacryocystorhinostomy (DCR) and compare the results with endoscopic DCR without silicone stenting. Design Prospective study, interventional type, randomized design and comparative analysis. Materials and methods The study was done in Department of Otorhinolaryngology, Government Medical College and Dr Susheela Tiwari Hospital, Haldwani, Uttarakhand. We included 30 patients in the study presenting with epiphora with or without mucocele and congenital cases of dacryocystitis and nasolacrimal duct (NLD) blockage were included in the study. All patients were divided into two groups. First one undergoing endoscopic DCR and silicone stent was used in all cases and second one underwent endoscopic DCR and no stent was used. Postoperative assessment was carried out at the end of 1st, 3rd, 6th and 10th week and the role of silicone stent was subjected to compare. Result Use of silicone stent was not improving the results and risk of failure of the surgery had increased with stent due to granulation formation in the lacrimal sac region. Apart from that, foreign body reactions in the form of irritation, pain were seen with stent. It also added the cost of surgery without giving much benefit to the patient. How to cite this article Ahmad S, Pant B. Role of Silicone Stenting in Endoscopic Dacryocystorhinostomy: A Comparative Study. Int J Adv Integ Med Sci 2016;1(1):4-6.

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Role of silicone stenting in endoscopic dacryocystorhinostomy

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20200136 ◽

2020 ◽

Vol 6 (2) ◽

pp. 248

Author(s):

Abdussalam M. Jahan ◽

Yousef M. Eldanfur ◽

Abdulhakim B. Ghuzi

Keyword(s):

Success Rate ◽

Medical Center ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

P Value ◽

Success Rates ◽

Duct Obstruction ◽

Significant Difference ◽

Silicone Stent ◽

Endoscopic Dcr

Background: Dacryocystorhinostomy (DCR) is a surgical procedure performed to relief nasolacrimal duct obstruction, which involves the creation of ostium at the lacrimal bone to form a shunt in the nasolacrimal pathway. Closure of the rhinostomy opening was considered a major factor for surgical failure. Use of silicone stent in endoscopic DCR to improve the success rate of the operation have been tried by many surgeons. In this study we assess the success rates of endoscopic DCR with and without silicone stents.Methods: Prospective study includes 30 patients were operated in the Department of ENT, Misrata Medical Center, from April 2017 to March 2018. They underwent endonasal endoscopic DCR for primary acquired nasolacrimal duct obstruction. These patients were randomly divided in two groups: A and B with 15 patients in each group. The group A patients underwent endoscopic DCR with silicone stent and group B patients underwent endoscopic DCR without stent. The results were statistically analyzed by chi-square test. Results: 30 patients were included in this study, their age ranged from 17 to 60 years, complaining of epiphora, 24 (80%) were females and 6 (20%) were males. The success rate was higher in patients with silicone stent (93.33%) as compared to patients without silicone stent (86.67%) but this difference in the results is not statistically significant (As p value is 0.542 which is >0.05).Conclusions: Endoscopic DCR is safe, successful procedure for treatment of nasolacrimal duct obstruction and there was no significant difference in the success rates of performing endonasal DCR with silicone or without silicone stents.

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ENDOSCOPIC ENDONASAL DACRYOCYSTORHINOSTOMY: EXPERIENCE OF HUNDRED CASES

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i6.4251 ◽

2021 ◽

Vol 71 (6) ◽

pp. 2104-08

Author(s):

Muhammad Shahid ◽

Muhammad Awais ◽

Amjad Akram ◽

Syed Abid Hassan Naqvi ◽

Omar Zafar ◽

...

Keyword(s):

Armed Forces ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Sample Population ◽

Endoscopic Endonasal ◽

Duct Obstruction ◽

Lacrimal System ◽

Chronic Dacryocystitis ◽

Quasi Experimental ◽

External Dacryocystorhinostomy

Objective: To determine the success rate of Endonasal Endoscopic Dacryocystorhinostomy (Endo-DCR) in cases of chronic dacryocystitis secondary to primary acquired nasolacrimal duct obstruction (NLDO). Study Design: Quasi-experimental study. Place and Duration of Study: Department of Oculoplastic Surgery, Armed Forces Institute of Ophthalmology Rawalpindi, from Sep 2018 to Nov 2019. Methodology: Endo-DCR under General Anaesthesia was performed on 100 patients of primary acquired nasolacrimal duct obstruction causing chronic dacryocystitis. Post-operatively these patients were checked on first post-op day, then on one week and finally four months after surgery. We removed silicone tubes of all the patients four months after surgery. To ensure patency of lacrimal passage, we did syringing and irrigation of lacrimal system of all cases, at conclusion of the study. We chose absence of epiphora and patent lacrimal system on syringing as indicators of successful procedure. Results: Hundred patients (males 37; females 63) were recruited for this study. Mean age of our sample population was 51.1 ± 29 years. Right nasolacrimal duct obstruction cases were 56 whereas left nasolacrimal duct obstruction cases were 44. Subjective improvement i.e., absence of epiphora was found in 90% patients. We got successful irrigation of lacrimal passages (objective improvement) in 94% of patients. Conclusion: Endo-DCR yields comparable results to external Dacryocystorhinostomy (Ex DCR). It offers additional benefits of esthetically better outcome, lesser complication rate and short surgery and patient recovery time.

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Anatomical and Functional Evaluation of Conventional vs Inferior Endoscopic Dacryocystorhinostomy in Study Cases of Idiopathic Chronic Dacryocystitis

Clinical Rhinology An International Journal ◽

10.5005/jp-journals-10013-1314 ◽

2017 ◽

Vol 10 (2) ◽

pp. 86-90

Author(s):

Aditya Kashyap ◽

Satisg Negi ◽

Prem L Chauhan ◽

Kuldeep Thakur

Keyword(s):

Operative Time ◽

Nasal Endoscopy ◽

Functional Evaluation ◽

Lacrimal Sac ◽

Endoscopic Dacryocystorhinostomy ◽

Group I ◽

Chronic Dacryocystitis ◽

Endoscopic Dcr ◽

Fluorescein Dye

ABSTRACT Objective To compare the results of conventional nasal endoscopic dacryocystorhinostomy (DCR) and inferior nasal endoscopic DCR in Study cases of idiopathic chronic dacryocystitis. Materials and methods Forty patients diagnosed with idiopathic chronic dacryocystitis were divided into two groups alternately. After relevant investigations, they were subjected for endoscopic DCR by two techniques. Twenty patients underwent conventional endoscopic DCR and 20 underwent inferior endoscopic DCR under transoral pterygopalatine block and topical lignocaine (4%) with adrenaline 1:2,000. After 3 months of follow-up in the outpatient department, nasal endoscopy along with fluorescein dye disappearance test (FDDT) at 10 minutes was done. Results Ninety-five percent (19/20) of patients undergoing conventional endoscopic DCR and 90% (18/20) of patients undergoing inferior endoscopic DCR were found to have patent anatomical fistula. On FDDT, nasal endoscopy after 10 minutes revealed 84% (16/19) in group I and 94.4% (17/18) in group II with fluorescein in nasal cavity. Conclusion Present study concludes the importance of bony, tendinous, and muscular support of lacrimal sac in physiological lacrimal pump functioning and advantage of relatively new technique of inferior endoscopic DCR. Inferior endoscopic DCR is associated with less operative time as well as less local complications. How to cite this article Thakur K, Kashyap A, Negi S, Chauhan PL. Anatomical and Functional Evaluation of Conventional vs Inferior Endoscopic Dacryocystorhinostomy in Study Cases of Idiopathic Chronic Dacryocystitis. Clin Rhinol An Int J 2017;10(2):86-90.

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Specific features of endoscopic dacryocystorhinostomy – case report

Romanian Journal of Rhinology ◽

10.1515/rjr-2015-0006 ◽

2015 ◽

Vol 5 (17) ◽

pp. 45-51

Author(s):

Lucian Lapusneanu ◽

Alina Neacsu ◽

Andreea Naca

Keyword(s):

Nasolacrimal Duct ◽

Stent Insertion ◽

Lacrimal Sac ◽

Endoscopic Dacryocystorhinostomy ◽

Evaluation Protocol ◽

Chronic Dacryocystitis ◽

History Of ◽

Ophthalmologic Examination ◽

Endoscopic Dcr ◽

Age Range

AbstractOBJECTIVE. The aim of the study was to evaluate the endoscopic dacryocystorhinostomy (DCR) with some particularities and its advantages over external DCR. MATERIAL AND METHODS. We evaluated 3 female patients (age range 35-84 years) diagnosed with chronic dacryocystitis - lacrimal sac abscess (2 cases) and lacrimal sac fistula (1 case). All patients presented a history of repeated episodes of acute dacryocystitis initially treated with broad spectrum antibiotics by the ophthalmologist. The evaluation protocol consisted in cranio-facial CT scan or MRI for the evaluation of the lacrimal sac and nasal structures, an ophthalmologic examination with the catheterization of the superior and inferior lacrimal punctum with a light probe to verify the permeability of the lacrimal pathway, and the Jones test with fluorescein to receive information about the common lacrimal path. Lacrimal syringing with regurgitation of fluid from the opposite punctum was the only criteria to decide the surgery. In all three cases we performed an endoscopic DCR, with stent insertion in two cases and a laco-dacryo-rhinostomy in one case. In only one case a reintervention was needed 12 months later. CONCLUSION. The endoscopic DCR, with its different particularities, is a safe surgical procedure with a low rate of complications, being the treatment of choice for the treatment of nasolacrimal duct obstruction.

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A New Modification in Endoscopic Endonasal Dacryocystorhi̇nostomy: Scopy-Guided Approach

10.21203/rs.3.rs-307225/v2 ◽

2021 ◽

Author(s):

Akalın İrfan ◽

Ahmet Kalkışım ◽

Hasan Gündoğdu

Keyword(s):

Surgical Intervention ◽

Nasolacrimal Duct ◽

Silicone Tube ◽

Endoscopic Endonasal ◽

New Approach ◽

Surgical Success ◽

Endoscopic Dacryocystorhinostomy ◽

Significant Difference ◽

Endoscopic Dcr ◽

Anatomical Success

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Endoscopic endonasal dacryocystorhinostomy-an experience in a tertiary care hospital

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20213891 ◽

2021 ◽

Vol 7 (10) ◽

pp. 1593

Author(s):

Atishkumar B. Gujrathi ◽

Paritosh A. Kamble ◽

Shashin Khadkekar ◽

Nishikant Gadpayale ◽

Yogesh Paikrao ◽

...

Keyword(s):

Tertiary Care ◽

Nasolacrimal Duct ◽

Care Hospital ◽

Lacrimal Sac ◽

Endoscopic Endonasal ◽

Pump System ◽

Medical College ◽

Affected Side ◽

Chronic Dacryocystitis ◽

Left And Right

Background: Dacryocystorhinostomy is a surgical procedure by which the lacrimal flow is diverted into the nasal cavity by making an opening in the lacrimal sac when the nasolacrimal duct gets blocked. The operation can be carried out using either an external or endonasal surgical approach.Methods: This is a clinical observational study done on 50 patients with chronic dacryocystitis with obstruction at the level of sac or nasolacrimal duct. This study was conducted at Dr. Shankarrao Chavan government medical college, Nanded, during the period of 2 years (2018-2020). Patients were evaluated and operated for endoscopic endonasal dacryocystorhinostomy.Results: The mean age of studied cases was 33.92±12.13 years. The M:F ratio was 0.78. Epiphora was the predominant complaint in all cases 100%. Swelling of lacrimal sac was present in 24% cases and Pain on affected side was present in 18% cases. 6% patients had fistula on the side of block. 12% patients had mucocele and 14% patients had pyocele on the affected side. Left and right side was involved in 54% and 40% cases respectively. The disease presented bilaterally in 06% cases. 80% patients had no complications after endonasal endoscopic dacryocystorhinostomy (EEDCR) surgery. Rate of surgical success was 92%.Conclusions: Nasolacrimal duct obstruction is more common among females and in middle aged persons. EEDCR is treatment which provides patients relief from the symptoms without any scar and also preserves nasolacrimal pump system with high success rate. It may prove better surgical technique in chronic dacryocystitis.

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Conventional Dacryocystorhinostomy Versus Pawar’s Implant Dacryocystorhinostomy- A Prospective Study

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol04-i01/533 ◽

2019 ◽

Vol 4 (01) ◽

Author(s):

Shivcharan Lal Chandravanshi ◽

Sunil Kumar Shrivastava ◽

Devendra Kkumar Shakya ◽

Uma Saran Tiwari

Keyword(s):

Success Rate ◽

Nasal Mucosa ◽

Clinical Success ◽

Operating Time ◽

Nasolacrimal Duct ◽

Operative Complication ◽

Chronic Dacryocystitis ◽

Group B ◽

Surgical Duration

Purpose: To compare conventional dacryocystorhinostomy (DCR) with Pawar’s intracystic implant dacryocystorhinostomy in terms of surgical technique, complications and success rate for primary acquired nasolacrimal duct obstruction (NLDO). Materials and Methods: This is a prospective comparative, nonrandomized, clinical study. It is carried out on 50 cases of primary acquired NLDO. The 50 cases were divide into two groups; Group A consisting of 30 cases that underwent Pawar’s intracystic implant DCR whereas Group B consisting of 20 cases those operated by conventional DCR technique. Data regarding demographic profile of patients, mode of presentation, diagnosis, intraoperative variables such as surgical duration, intra- and post-operative complications, hospital stay and causes of failure and final surgical outcome, were analyzed. Clinical success was defined as patent lacrimal system on irrigation (objective) and absence of symptoms (subjective). Results: Out of 50 cases 40 (80%) were female and 10 cases (20%) were males. In this study, 39 (78%) cases had chronic dacryocystitis, followed by pyocele/mucocele 5 (10%), chronic dacryocystitis with lacrimal fistula 3 (6%), and previous failed DCR surgery 3 (6%). Hemorrhage from nasal mucosa was observed in 9 cases (45%) during conventional DCR surgery and one case (3.33%) in implant DCR. Hemorrhage from angular vein occurred in 1 case (5%) during conventional DCR. Nasal mucosa was disrupted/damage in 8 cases (40%) during conventional DCR. The average operating time in convention DCR is 110.50 minutes while for Pwar’s implant DCR is 27.33 minutes. The commonest post-operative complication of Pawar’s intracystic implant DCR was obstruction of passage found in 4 cases (13.33%). Hypertrophic scar was the most common postoperative complication in 8 cases (40%) in conventional DCR. Success rate of implant DCR at 2 months follow up was 83.33% and at the end of 3 months after management of failed cases of implant DCR was 96.66%. Success rate of conventional DCR at 2 months follow up was 80% and at the end of 3 months after management of failed cases of conventional DCR was 85%. Conclusion: The success rate of Pawar’s intracystic implant DCR is comparable with conventional DCR with additional advantages such as easy, quick, minimal intra- and post operative complication and possibility of conventional DCR in future in failed Pawar’s implant DCR.

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