scholarly journals Combined endoscopic endonasal and subciliary approach in revision DCR cases

2017 ◽  
Vol 3 (3) ◽  
pp. 693
Author(s):  
Manjunatharao S. V. ◽  
Rajshekar M. M.
Keyword(s):  
Team Work ◽  
Tertiary Level ◽  
External Approach ◽  
Combined Approach ◽  
Interventional Study ◽  
Endoscopic Endonasal ◽  
Subciliary Approach ◽  
Endoscopic Dcr ◽  
Surgical Field ◽  
External Dcr

<p class="abstract"><strong>Background:</strong> Study conducted to know surgical outcome of combined endoscopic endonasal and subciliary approach in revision DCR cases and complications associated with the procedure.</p><p class="abstract"><strong>Methods:</strong> Prospective, single-blinded, randomized, interventional study is carried out in Tertiary level center from August 2009 to April 2016. Totally 18 patients (11 female and 7 male) were involved in the study who has undergone previous DCR (11 external DCR and 7 endoscopic DCR). The results were analyzed at end of the 3<sup>rd</sup> and 6<sup>th</sup> month both subjectively and objectively.  </p><p class="abstract"><strong>Results:</strong> All the 18 patients who underwent combined approach were relived from epiphora. None of the patients developed any complications following surgery.</p><p><strong>Conclusions:</strong> The combination of endoscopic and external approach gives benefits of the both approaches giving huge advantages in revision cases. It gives excellent visualization of the surgical field, ability to correct internal nasal pathologies, make clear rhinostoma, workprecisely on fibrosed lacrimal sac and nearly no external scar. It provides good team work opportunity between otorhinologist and ophthalmologist.</p>

scholarly journals Endoscopic Dacryocystorhinostomy: Advantage over External Approach

2019 ◽  
Vol 27 (2) ◽  
pp. 161-166
Author(s):  
Bijan Basak ◽  
Kaustuv Das Biswas ◽  
Subhradev Biswas ◽  
Ankit Choudhary
Keyword(s):  
Standard Treatment ◽  
Nasolacrimal Duct ◽  
External Approach ◽  
Interventional Study ◽  
Safe Alternative ◽  
Endoscopic Dacryocystorhinostomy ◽  
Chronic Dacryocystitis ◽  
Endoscopic Dcr ◽  
Prospective Longitudinal ◽  
External Dcr

Introduction Although external DCR was considered to be the Gold Standard treatment for NLD obstruction, endoscopic DCR appears to give comparable results,  with the advantage of the absence of external facial scar and no disruption of the medial palpebral ligament or the angular facial vessels. This study aims to evaluate the outcome of endoscopic dacryocystorhinostomy (DCR) and compare with the outcome of external DCR, based on data available on literature search. Materials and Methods In this prospective, longitudinal, interventional study, 67 cases of chronic dacryocystitis were operated endoscopically from January 2017 to December 2018. All patients were documented about detailed medical and operative history, thorough medical check up including ocular and ENT examination. Level of obstruction of nasolacrimal duct (NLD) was diagnosed by lacrimal syringing and probing. Surgery was performed under local anaesthesia except in uncooperative patients where general anaesthesia was used. 0˚ & 30˚ endoscopes were used in surgery. The surgical outcomes and complications were recorded, analyzed and compared to those of external DCR from available literature.   Results The overall success rate of endoscopic DCR was 94.7%, which is closely comparable to external DCR. Conclusion Endoscopic DCR is an effective and safe alternative to external DCR, with comparable results and better patient satisfaction.

scholarly journals A Comparative Study between Endoscopic Dacryocystorhinostomy and External Dacryocystorhinostomy – A Hospital-Based Study

2020 ◽  
Vol 7 (44) ◽  
pp. 2526-2529
Author(s):  
Kanishka Chowdhury ◽  
Sagar Karmakar ◽  
Subhadip Sarkar ◽  
Suman Mukhopadhyay
Keyword(s):  
Invasive Procedure ◽  
External Approach ◽  
Medical College ◽  
Chronic Dacryocystitis ◽  
Group A ◽  
Study Population ◽  
Endoscopic Dcr ◽  
External Dacryocystorhinostomy ◽  
Group B ◽  
External Dcr

BACKGROUND Dacryocystorhinostomy (DCR) can be performed via two approaches either external approach or endonasally. Earlier, external approach was preferred but with the recent introduction of endoscopy, the focus has shifted to endoscopic DCR as it is a less invasive procedure. This study was conducted to compare both the approaches. METHODS 50 patients were selected from patients attending eye and ENT OPD of a medical college in Kolkata with complaints of watering and / or discharge or with other features of chronic dacryocystitis e.g., mucocele, pyocele etc. They were then allocated in to two groups, group A (patients who will undergo endo DCR) and group B (patients who will undergo external DCR). Results of both were compared. RESULTS The mean age of study population was 34.34 ± 6.65 yrs. Among the study population, 36 patients (72 %) were female and 14 were male (28 %). Mean age of Group A (i.e. patients subjected to endo DCR) was 34.60 ± 5.72, while that of Group B (patients undergone external DCR) was 34.08 ± 7.58 yrs. Patients had a right sided predilection for DCR operation (66 %). Most common presenting symptom was epiphora (66 %) followed by epiphora with discharge. Mean time taken for the operation was significantly (p < 0.0001) more in group B (117 ± 14.43 mins) compared to that in group A (46.60 ± 8.63 mins). Massive intraoperative bleeding was more common in group B (32 %) compared to that in group A (p = 0.0023). Group B had a significantly higher rate of post-operative complications (56 %) compared to that in group A (p = 0.00085). Group B also had a higher success rate compared to group A; but this difference was not significant. (p = 0.22144). CONCLUSIONS Both the approaches have their own merits and demerits; but both are accepted alternatives, so either approach could be performed depending on the situation. KEYWORDS Endoscopic DCR, External DCR, Epiphora

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 A New Modification in Endoscopic Endonasal Dacryocystorhi̇nostomy Scopy-Guided Approach

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.

Anatomic Nuances of the Ophthalmic Artery Origin from a Ventral Viewpoint: Considerations and Implications for Endoscopic Endonasal Surgery

2018 ◽  
Vol 16 (4) ◽  
pp. 478-485
Author(s):  
Cristian A Naudy ◽  
Juan C Yanez-Siller ◽  
Paulo M Mesquita Filho ◽  
Matias Gomez G. ◽  
Bradley A Otto ◽  
...  
Keyword(s):  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Point Of View ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Nerve Segment ◽  
Surgical Field ◽  
The Right ◽  
Ophthalmic Arteries

Abstract BACKGROUND The origin of the ophthalmic artery is within the surgical field of endoscopic endonasal approaches (EEAs) to the suprasellar and parasellar regions. However, its anatomy from the endoscopic point-of-view has not been adequately elucidated. OBJECTIVE To highlight the anatomy of the ophthalmic artery origin from an endoscopic endonasal perspective. METHODS The origin of the ophthalmic artery was studied bilaterally under endoscopic visualization, after performing transplanum/transtubercular EEAs in 17 cadaveric specimens (34 arteries). Anatomic relationships relevant to surgery were evaluated. To complement the cadaveric findings, the ophthalmic artery origin was reviewed in 200 “normal” angiographic studies. RESULTS On the right side, 70.6% of ophthalmic arteries emerged from the superior aspect, while 17.6% and 11.8% emerged from the superomedial and superolateral aspects of the intradural internal carotid artery, respectively. On the left, 76.5%, 17.6%, and 5.9% of ophthalmic arteries emerged from the superior, superomedial, and superolateral aspects of the internal carotid, respectively. Similar findings were observed on angiography. All ophthalmic arteries emerged at the level of the medial opticocarotid recess. Overall, 47%, 26.5%, and 26.5% of ophthalmic arteries (right and left) were inferolateral, inferior, and inferomedial to the intracranial optic nerve segment, respectively. On both sides, the intracranial length of the ophthalmic artery ranged from 1.5 to 4.5 mm (mean: 2.90 ± standard deviation of 0.74 mm). CONCLUSION Awareness of the endoscopic nuances of the ophthalmic artery origin is paramount to minimize the risk of sight-threatening neurovascular injury during EEAs to the suprasellar and parasellar regions.

The Endoscopic Diving Technique in Pituitary and Cranial Base Surgery

Neurosurgery ◽  
2010 ◽  
Vol 66 (2) ◽  
pp. E400-E401 ◽  
Author(s):  
Davide Locatelli ◽  
Frank Rikki Canevari ◽  
Ilaria Acchiardi ◽  
Paolo Castelnuovo
Keyword(s):  
Cavernous Sinus ◽  
Surgical Procedures ◽  
Endoscopic Surgical Procedures ◽  
Endoscopic Endonasal ◽  
Tumor Residue ◽  
Sinus Cavity ◽  
Cranial Base Surgery ◽  
Cranial Fossa ◽  
Surgical Field ◽  
Base Of The Skull

Abstract OBJECTIVE We used the diving technique to go beyond mere visualization of the surgical field and used it as an important step in removing the lesion itself, improving the optical field, and optimizing visualization with a dynamic fluid film lens. Likewise, having extended endoscopic endonasal surgery to the entire base of the skull and in particular to the sinus cavity, “diving surgery” has proven to be effective in visualizing and dissecting more extended tumors. METHODS We performed diving surgery in more than 350 surgical procedures to remove lesions in the sellar, sinus cavity, and clival regions. Intrasellar hydroscopy was performed in all cases to check that the lesion was removed completely and to gently dissect any intracavitary residual tumoral tissue. Diving surgery can be performed in the sellar cavity, in the cavernous sinus, and at the level of the posterior cranial fossa in the cavity obtained after clivectomy. RESULTS The hydrodissection and continuous flushing of the sellar cavity, together with better control of bleeding, allow the surgeon to perform piecemeal removal of the lesion with direct control of the cleavage plane and tumor residue and avoid blind curettage near the pituitary gland. This technique is particularly useful in identifying small infiltrations of the cavernous sinus and in checking the integrity of the pituitary stalk when instruments are introduced into the sella. CONCLUSION Diving surgery is a useful step in dealing with minor complications that can occur during endonasal endoscopic surgical procedures.

scholarly journals Outcomes of external dacryocystorhinostomy and endoscopic endonasal dacryocystorhinostomy in the management of nasolacrimal duct obstruction

2015 ◽  
Vol 7 (1) ◽  
pp. 39-46 ◽  
Author(s):  
S Duwal ◽  
R Saiju
Keyword(s):  
Success Rate ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Endoscopic Endonasal ◽  
Duct Obstruction ◽  
Dence Interval ◽  
External Dacryocystorhinostomy ◽  
Group 2 ◽  
External Dcr ◽  
Group 1

Introduction: Dacryocystorhinostomy (DCR) is the treatment of choice for nasolacrimal duct obstruction. Although external DCR is regarded as the gold standard, endoscopic DCR is evolving as an equally-effective alternative. Objectives To compare the success rate of treating nasolacrimal duct obstruction by endoscopic endonasal method compared to the conventional DCR surgery.Materials and methods This prospective, comparative, non-randomised study was conducted in 2009 - 2010. Thirty consecutive patients undergoing endoscopic endonasal DCR (Group 1) and 30 consecutive patients undergoing external DCR (Group 2) between July 2009 and September 2010 at the oculoplasty unit of the Tilganga institute of ophthalmology were included in this study. A patent lacrimal passage on syringing and symptomatic improvement at six months after surgery was de¿ned as a successful outcome. The intraoperative and postoperative complications were also compared. Results Our study included 31 eyes of 30 patients in Group 1 and 34 eyes of 30 patients in Group 2. The success rate for endoscopic endonasal dacryocystorhinostomy was 90.3 % (95 % con¿dence interval 80 - 100) and external dacryocystorhinostomy was 94.1 % (95 % con¿dence interval 80 - 100). The difference of surgical success among the two methods was not statistically significant (p = 0.7). The rate of intra-operative and post-operative complications was similar in the two methods (p = 0.5). Conclusion: The short term outcomes and complication rates of endoscopic endonasal dacryocystorhinostomy and external dacryocystorhinostomy were similar.

Sign in / Sign up

Export Citation Format

Share Document