Endonasal dacryocystorhinostomy: evaluation of the anatomical and functional results
Keywords:Nasolacrimal duct obstruction, Endoscopic dacryocystorhinostomy, Neo-ostium
Background: Dacryocystorhinostomy is a novel surgical technique for NLD obstruction performed by external and endonasal approach. Both procedures have variable success rates and advantages or disadvantages. The objectives were to study functional and anatomic outcomes of endoscopic DCR and to assess degree of ostium shrinkage in postoperative period.
Methods: Prospective study comprising 68 patients of NLD obstruction with 70 procedures performed during the period of October 2014 to October 2016. Various dimensions of bony neo-ostium were recorded intraoperatively and during 1st and 3rd month follow up. Mitomycin C was applied in 37 cases. Degree of ostium shrinkage and its correlation with surgical success was studied. Outcome of study was measured as functional and anatomical success.
Results: 68 patients in age range of 7 to 71 years. Mean intraoperative height and width were 12.0±2.08 mm and 5.17±0.82 mm respectively and intraoperative surface area of ostium was 62.77±17.27mm2. The study showed strong positive correlation between initial and final ostium size. The final ostium irrespective of its size, if patent does not result in recurrence of symptoms and can be considered as success. In the present study, functional and anatomical success was 97.14% and failure rate was 2.86%.
Conclusions: Both functional and anatomical success require creation of patent neo-ostium, although the intraoperative size of ostium is not the deciding factor for final outcome. Complete exposure of lacrimal sac, adequate mucosal preservation, good marsupialization and mucosal apposition are the some of the crucial factors responsible for stable ostium patency and hence the surgical success.
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