Early bi-canalicular silicone stent intubation in failed DCR with endoscopic visualization: a combined approach
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20191619Keywords:
Dacryocystitis, Dacryocystorhinostomy, Endoscopic DCR, Bi-canalicular silicone intubationAbstract
Background: Chronic dacryosystitis is a common condition affecting the eye and presenting to ENT surgeons and ophthalmologists, and treated with DCR (dacryocystorhinostomy). In few cases there can be recurrence of symptoms following DCR surgery which can be treated with bi-canalicular silicone intubation. The aim of this study is to assess the effectiveness of an early bi-canalicular silicone intubation in patients with failed DCR using endoscopic visualisation.
Methods: This was a prospective observational study. Thirteen cases of DCR operated for chronic dacryocystitis at St John’s Medical College Hospital were reviewed between January 2014 and February 2017. Endoscopic DCR was done for five patients and external DCR for eight patients, number of males were 5 (38%) and females were 8 (62%). Age: 9–73 years (avg: 40.5 years).
Results: Nine patients had complete resolution of symptoms following the primary DCR (4 following external DCR and 5 following endonasal endoscopic DCR). Four patients had failed DCR with persistence of watering three months following primary DCR surgery. Re-DCR with bi - canalicular silicon stent intubation was done in failed cases. Postoperative follow up of all the four patients showed complete resolution of symptoms.
Conclusions: Failed DCR surgeries can be effectively intubated using bi–canlicular silicon tubes in the early postoperative period following DCR surgery. Silicone tube intubation is the most safe and cost effective method. Endoscopic visualization gives an added advantage of localizing the cause for a failed DCR.
References
Wormald PJ, Kew J, Van Hasselt A.Intranasal anatomy of the nasolacrimal sac in endoscopic dacryocystorhinostomy. Otolaryngol Head Neck Surg. 2000;123:307–10.
Bolger WE, Parsons DS, Mair EA, Kuhn FA. Lacrimal drainage system injury in functional endoscopic sinus surgery. Incidence, analysis, and prevention. Arch Otolaryngol Head Neck Surg 1992;118:1179–84.
Hossain MI, Nahar L, Rashid MA. Re-DCR with Silicone Tube Intubation:An Effective Method of Management of Failed DCR. Mymensingh Med J. 2015;24(4):661-4.
Saeed BM, Tawalbeh M. Pediatric Endoscopic DCR. The Outcome in 50 patients. Indian J Otolaryngol Head Neck Surg. 2014;66(3):276–80.
Akcay E, Yuksel N, Ozen U. Revision External DCR Results after a Failed DCR Surgery. Ophthalmol Ther. 2016;5(1):75–80.
Selcuk A, Ozcan KM, Ozcam I, Dere H. Bifid inferior turbinate: a case report. J Laryngo Otol. 2008;122(6):647-9.
Lee SY, Bae KE, Lee HB, Cho WH, Kim JH, Cho HS, et al. Bilateral accessory inferior turbinates and secondary middle turbinates. JPN J Radiol. 2012;30(6):530-2.
Aksungur EH, Bickakci K, Inal M, Akgul E, Binokay F, Ayodgam B, et al. CT demonstration of accessory nasal turbinates: secondary middle turbinate and bifid Inferior turbinate. Eur J Radiol. 1999;31(3):174-6.
Ari S, Kursat Cingu A, Sahin A, Gun R, Kinis V, Caca I. Outcomes of revision external dacryocystorhinostomy and nasal intubation by bicamnalicular silicone tubing under endonasal endoscopic guidance. Int J Ophthalmol. 2012;(2):238-241
Okuyucu S, Gorur H, Oksuz H, Akoglu E. Endoscopic dacryocystorhinostomy with silicone, polypropylene, and T-tube stents;randomized controlled trial of efficacy and safety. Am J Rhinol Allergy. 2015;29(1):63–68.
Dalez D, Lemagne JM. Transcanalicular dacryocystorhinostomy by pulse Holmium- YAG laser. Bull Soc Belge Ophthalmol. 1996;263:139–40.
Sharma BR. Non endoscopic endonasal dacryocystorhinostomy versus external dacryocystorhinostomy. Kathmandu Univ Med J (KUMJ). 2008;6:437–42.
Mickelson SA, Kim DK, Stein IM. Endoscopic laser assisted dacryocystorhinostomy. Am J Otolaryngol. 1997;18:107–111.
Metson R. The endoscopic approach to revision dacryocystorhinostomy. Laryngoscope. 1990;100:1344–7.
Keerl R, Weber R. Dacryocystorhinostomy - state of the art, indications, results. Laryngorhinootologie. 2004;83(1):40-50.