Benign growths, sinonasal polyposis, septal deviations, allergic rhinitis, atrophic rhinitis, are all patients fit to be taken up for surgery, but since the pathology could be causative factor should be eliminated beforesimultaneously or after the endonasal dcr procedure. Nasal sprays may also be prescribed, and instructions about their. Jul 12, 2011 a comparison of external and endoscopic endonasal dacryocystorhinostomy for acquired nasolacrimal duct obstruction r karim, r ghabrial, tf lynch, b tangschool of public health, faculty of medicine, university of sydney, sydney, australiapurpose. In the case of cicatricial obstruction at the osteotomy site, it is easier to perform endoscopic revision, and the patient is more likely to accept such a revision without visible external cuts. Those corrections result not only in relief of residual tension around the skull but changes in the entire body. The righthanded surgeon takes position on the right side of the patient for both right and left sided endonasal dcr and directly views the transilluminated target area fig. The external dcr is still the gold standard, and improvent in this context is. External versus endonasal dacryocystorhinostomy in a. Dcr burrs, the endonasal approach is being used more and. A square nasal mucosal flap was incised by a blade a and a power blur then was used to thin maxilla and frontal process of the maxilla b, a rongeur to remove the bone c, and a probe to bulge medial sac and allow the medial wall of the sac fully incised d. This video demonstrates endoscopic dcr performed on a 57yearold female. Endonasal dcr should not be done when malignant tumour is in proximity of nldit is may be cause of obstruction. The success rates for mechanical endonasal dcr reported by tsirbas and wormald 1 appear to be very good 95% anatomical and 89% functional success, but their follow up period varied from only 2 months to 28 months mean 9. Depending on the preference of the surgeon, more postoperative care may be required for patients undergoing endonasal dcr than.
Some of the patients who had only a short follow up time may subsequently fail. Several ophthalmologists fear performing dcr because of bleeding and unfamiliarity. Endonasal cranial correction advanced biostructural. For bone removal, kerrisons punch and dcr burr was used. Successful endonasal dacryocystorhinostomy in a patient with wegeners granulomatosis article pdf available in clinical ophthalmology 3default. Comparative study of recessive spherical headed silicone. The latter approach fell out of favor because of difficult visualization and endonasal access to the lacrimal sac. The study conducted in tertiary care centre of fifty patients presenting with symptoms and signs suggestive of nasolacrimal duct obstruction.
Females have significantly smaller dimensions in the lower nasolacrimal fossa and middle nasolacrimal duct. It can be performed under 20 min without mucosal flap preservation, mitomycin local application, silicon tube stenting or laser assistance and can still provide a good success rate. Nasal sprays may also be prescribed, and instructions about their use will be provided. Published success rates for external dcr, endonasal dcr and endocanalicular laser dcr range widely from 50% to 99%.
This technique was later modified by west and supported by mosher in 1921. Nonendoscopic mechanical endonasal dacryocystorhinostomy. Dacryocystorhinostomy dcr surgery is a procedure that aims to eliminate fluid and mucus retention within the lacrimal sac, and to increase tear drainage for relief of epiphora water running down the face. Despite ease and decreased morbidity of endonasal dcr, external dcr is the procedure of choice as it is more successful. The efficacy of application of mitomycinc in endoscopic endonasal dacryocystorhinostomy pages. Disadvantages of endonasal dcr include the preferred use of general anesthesia by many surgeons, the high cost of expensive equipment and instrumentation, and the relatively steep learning curve for this. Pdf to describe the technique of nonendoscopic endonasal dacryocystorhinostomy nendcr, and its indications and results. Comparing outcomes of the standard technique of endoscopic. However, with the newer, rigid telescopes, these difficulties have been overcome, resulting in a resurgence of the endoscopic technique. Endonasal dcr is far superior than external dcr reason is simple and obvious.
To compare success rates of external dacryocystorhinostomy dcr and endoscopic endonasal dcr for acquired nasolacrimal duct obstruction nldo. Pdf successful endonasal dacryocystorhinostomy in a. In 1893, caldwell described the first case of an endonasal operative approach to the lacrimal system. A lot of ophthalmologists fear performing dcr because of bleeding and unfamiliarity of structure.
His group also found the nasal approach more rapid and more acceptable to patients who had an alternative technique used on the other side. The main argument for an endonasal approach is the lack of a scar. Despite ease and decreased morbidity of endonasal dcr, external dcr is procedure of choice as it is more successful. Bicanalicular silicone stents in endonasal dcr american. Endoscopic dacryocystorhinostomy has now established itself in the treatment of lacrimal obstruction. The efficacy of application of mitomycinc in endoscopic. Exdcr was first described by toti in 1904 and is the most widely practiced procedure. Pdf the impact of endonasal dacryocystorhinostomy dcr. Conclusion standard endoscopic dcr and its more sophisticated modifications were equally effective and safe in managing distal nasolacrimal drainage obstruction. Instructions following endonasal dcr surgery other medications pg2 eye drops, if prescribed, are instilled into the eye 3 times a day. Several ophthalmologists fear performing dcr because of bleeding and unfamiliarity of structure.
External in short, both techniques are highly successful. Because of difficulty in visualizing the nasal cavity, the endonasal approach fell out of favor, and for the next 100 years, a slightly modified external approach remained the treatment of choice for primary acquired nasolacrimal duct obstructions pando. Jul 28, 2017 a modified preserved nasal and lacrimal mucosal flap technique in endoscopic dacryocystorhinostomy. Endonasal dacryocystorhinostomy ota american academy of. This study evaluates the preservation of lacrimal pump function in both. A dcr procedure involves removal of bone adjacent to the nasolacrimal sac and incorporating the lacrimal sac with the lateral nasal. Compared with external dcr, endoscopic dcr is more. Conventional dacryocystorhinostomy versus endonasal. Since then, endonasal endoscopic dcr ees dcr was performed more frequently in pando and successful results were reported. Restenosis or scar formation probably is correlated with. Epiphora, or abnormal tearing, occurs because of blockage in the lacrimal drainage system, which impairs normal tear channeling into the nose.
A modified preserved nasal and lacrimal flap technique in. One trial from finland compared laserassisted endonasal dcr with external dcr, and one trial from india compared mechanical endonasal dcr using punch forceps. All endcr surgeries will be performed by a single ophthalmic plastic surgeon expert in endoscopic surgery f. Pdf the impact of endonasal dacryocystorhinostomy dcr, on. The success rates for mechanical endonasal dcr reported by tsirbas and wormald 1 appear to be very good 95% anatomical and 89% functional success, but their follow up period varied from only 2. Aug 10, 2017 comparative study of recessive spherical headed silicone intubation and endonasal dacryocystorhinostomy under nasal endoscopy for nasolacrimal duct obstruction huiyi deng 1 na1.
In spite of these attempts, the external dacryocystorhinostomy dcrthe technique inaugurated by toti in 1904was, for a long time, the most accepted procedure for lacrimal sac surgery. Disadvantages of endonasal dcr include the preferred use of general anesthesia by many surgeons, the high cost of expensive equipment and instrumentation, and the relatively steep learning curve for this procedure. However, its distal end has been shown to be occluded by a membrane in 73% of otherwise normal stillborn fetuses at term. An assessment of those significant reports about dcr techniques. Different surgical techniques for treating blockage of the. Comparative study of recessive spherical headed silicone intubation and endonasal dacryocystorhinostomy under nasal endoscopy for nasolacrimal duct obstruction huiyi deng 1 na1.
Endoscopic endonasal dcr plays an established role in revision dcr surgery. Jul 30, 2018 toti first described the external approach in 1904. To describe and assess the efficacy of mechanical endonasal dacryocystorhinostomy mendcr. May 24, 2016 this video demonstrates endoscopic dcr performed on a 57yearold female. Endonasal dcr may be useful in the management of acute dacryocystitis with abscess formation,10, 58 unlike external dcr, which is often considered to be contraindicated in this setting. Longterm results of endonasal dacryocystorhinostomy. Our experience endonasal dacryocystorhinostomy is considered to be the standard treatment for chronic dacryocystitis, and is simple to perform and is very effective even in. Endonasal endoscopic dcr is a viable alternative to external dcr, coexisting sinonasal diseases can be managed simultaneously, as may be required in 25% of cases. Pdf successful endonasal dacryocystorhinostomy in a patient. Pdf on dec 10, 2018, balwant singh gendeh and others. Endoscopic dacryocystorhinostomy oculoplastic eyelid.
It can be done with external ex or endonasal en access. Comparative study of endonasal dacryocystorhinostomy with. Endonasal endoscopic dcr is the best at present treatment of dcr. Mean operating time was lowest for balloon dcr mean sd, 27. Despite much debate, many still believe that external dcr provides a high success rates than endoscopic dcr though many types of endonasal approaches have been attempted, long term. This is a new technique that involves creation of a large rhinostomy and mucosal flaps. Comparative study of endonasal dacryocystorhinostomy with and. Endoscopic endonasal dacryocystorhinostomy dcr is the best, scar free no scar, lacrimal surgery performed for restoration of tears flow into the nose from the lacrimal sac, when the nasolacrimal duct tear duct has become blocked blocked tear duct tear duct obstruction abnormal tearing or epiphora watery eyes takes place due to obstruction in the drainage system of. However, its distal end has been shown to be occluded by a membrane in 73% of otherwise.
Endoscopic endonasal dacryocystorhinostomy combined with. Mechanical endonasal dacryocystorhinostomy with mucosal. A square nasal mucosal flap was incised by a blade a and a power blur then was used to thin maxilla and frontal process of the maxilla b, a rongeur to remove the bone c, and a probe to bulge. Our experience endonasal dacryocystorhinostomy is considered to be the standard treatment for chronic dacryocystitis, and is simple to perform and is very effective even in patients. Cases of successful endcr 4 patients and exdcr 4 patients were included. The standard surgical procedure for treatment of nasolacrimal duct obstruction nldo is dacryocystorhinostomy dcr which restores normal lacrimal outflow. This article tries to provide few tips to make dcr easy and stressfree. The basic indication is same in all cases and either route can be used. Endonasal cranial correction advanced biostructural correction. Editor,canalisation of the nasolacrimal apparatus usually occurs at the same time throughout its length. Endonasal dacryocystorhinostomy, our experience iris publishers.
Mri evaluation of lacrimal drainage after external and. You may also be prescribed antibiotic tablets or capsules. The study involved a prospective nonrandomised interventional case series with short perioperative follow up. External and endonasal dacryocystorhinostomy exdcr and endcr, respectively affect the tear drainage mechanism. Nov 30, 2011 endonasal dcr is far superior than external dcr reason is simple and obvious. Nonendoscopic endonasal dacryocystorhinostomy springerlink. It is unclear whether or not endonasal dacryocystorhinostomy dcr is a better way of treating tear duct obstruction than external dcr very lowcertainty evidence, nor is it clear whether endonasal dcr reduces the chance of complications such as bleeding or wound infection very lowcertainty evidence. Clinical study endoscopic endonasal dacryocystorhinostomy.
Abnormal tearing or epiphora watery eyes takes place due to obstruction in. Abc endonasal cranial correction ecc is a proven and effective method that helps bring the body back into alignment through the correction of cranial bones out of place in a direction the body cannot. Endoscopic endonasal dacryocystorhinostomy dcr is the best, scar free no scar, lacrimal surgery performed for restoration of tears flow into the nose from the lacrimal sac, when the. The files of 165 patients who underwent endonasal dcr at a tertiary referral centre between 1991 and 2001 were retrospectively assessed. This document describes endonasal dacryocystorhinostomy dcr and examines the evidence. Oct 04, 20 despite much debate, many still believe that external dcr provides a high success rates than endoscopic dcr though many types of endonasal approaches have been attempted, long term success rates are less than ext. The success rates for endonasal dacryocystorhinostomy. Abc endonasal cranial correction ecc is a proven and effective method that helps bring the body back into alignment through the correction of cranial bones out of place in a direction the body cannot selfcorrect. Benign growths, sinonasal polyposis, septal deviations, allergic rhinitis. Nov 30, 2011 endonasal dcr should not be done when malignant tumour is in proximity of nldit is may be cause of obstruction. Successful endonasal dacryocystorhinostomy in a patient with wegeners granulomatosis. Endoscopic endonasal dacryocystorhinostomy dcr is the best, scar free no scar, lacrimal surgery performed for restoration of tears flow into the nose from the lacrimal sac, when the nasolacrimal duct tear duct has become blocked blocked tear duct tear duct obstruction. Also, these patients tend to be of an older age group that are not conscious of a small scar by the side of the eye.
In the case of cicatricial obstruction at the osteotomy site, it is easier to perform endoscopic revision, and the patient is more. This surgical technique employed by ent surgeons, has certain advantages over. In good hands however, the scar is very inconspicuous. Otorhinolaryngology, head and neck surgery, the university of adelaide, adelaide, sa, australia aim. Primary failure rates of external dcr have been less than 10%. Endonasal endoscopic dcr and externaldcr in primary. Under endoscopic guidance nasal anatomy is understood directly, managed accordingly, sac is approached directly under vision and so at the time of surgery result is known. This study evaluates the preservation of lacrimal pump function in both procedures. A comparison of external and endoscopic endonasal dacryocystorhinostomy for acquired nasolacrimal duct obstruction r karim, r ghabrial, tf lynch, b tangschool of public health, faculty of. Most of patients are females so if in any way a scar can be prevented over face will be a better option 4.
A modified preserved nasal and lacrimal mucosal flap technique in endoscopic dacryocystorhinostomy. Endoscopic dacryocystorhinostomy oculoplastic eyelid orbit. Caldwell 1 and toti 2, respectively, described the endonasal and external approaches to dacryocystorhinostomy dcr 1, 2. Dec 15, 2016 all en dcr surgeries will be performed by a single ophthalmic plastic surgeon expert in endoscopic surgery f. The external dcr is still the gold standard, and improvent in this context is referred in terms of decreased surgery time, diminished convalescence, and enhanced cosmesis. Because of difficulty in visualizing the nasal cavity, the endonasal. Using a 0 degree 4mm endonasal endoscope nasal mucoperiosteum in the area of the lacrimal sac will be incised and elevated.
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