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. The impact of endonasal dacryocystorhinostomy dcr, on. Pdf cause and management of patients with failed endonasal. Sep 01, 2014 external dcr was the gold standard treatment for nldo for more than 100 years and had a high success rate of 90% and above. Endonasal endoscopic dcr and externaldcr in primary. I am grateful to kuopio university language centre for inventing the writing clinic and especially to. Understanding endonasal anatomy, wide endoscopic marsupialisation of the lacrimal sac, and meticulous care of the.
A comparison of endonasal dacryocystorhinostomy and external. Results of nonendoscopic endonasal dacryocystorhinostomy passorn preechawaidepartment of ophthalmology, faculty of medicine, prince of songkla university, hat yai, songkhla, thailandbackground. Compared with external dcr, endoscopic dcr is more. All studies included were required to provide the success rates of both the mmc and control groups, and the followup time was up to 3 months.
Excessive tearing or troublesome watering with tears overflowing down the cheek can have many different dcrcauses, and there are several different surgical options, including dcr surgery. The success rate in this study in the endonasal dcr group with mitomycin c application was 97%. Endonasal dacryocystorhinostomy, mechanical, nasolacrimal duct obstruction. To assess the efficacy of endonasal dacryocystorhinostomy dcr compared with external dcr.
The success rate of external dcr has improved to the present day with few modifications and may be up to 90. Paediatric endoscopic and external dcr have similar success rates of around 8396%. Early tube removal did not adversely affect the outcome in the majority of cases in which it occurred, and removal at 6 weeks should now be regarded as the norm. Surprisingly though, endonasal dcr was described by caldwell in 1893 much before toti described his external approach 4. Backgroundaims endonasal laser dacryocystorhinostomy eldcr has. This requires removal of the small amount of bone that lies between your tear sac and your nose. Endolacrimal ktp laserassisted dacryocystorhinostomy. A 64yearold woman presented with a medial canthal mass in her left eye, which was accompanied only by mild epiphora. This study was carried out to evaluate the results of endonasal dcr surgery and to access efficacy of this procedure without stenting. Dcr is sometimes required for paediatric congenital or acquired nasolacrimal duct obstruction. Advantages of endonasal dcr over the external approach include less morbidity, reduced intraoperative bleeding. Dacryocystorhinostomy dcr has been shown to be a safe, effective intervention 2,3 but failures and complications are more common in this patient group. Endonasal dcr, powered dcr, dacryocystorhinostomy introduction dacryocystorhinostomy dcr is surgical procedure done for epiphora due to nasolacrimal duct obstruction nldo, which involves creating a fistulous opening between the lacrimal sac and the nasal cavity at the level of the middle meatus.
Endoscopic dacryocystorhinostomy to treat congenital nasolacrimal. To examine the effectiveness of a management protocol for childhood epiphora using a joint ophthalmological and otolaryngological team approach. Failing or failed endonasal dcr can occur from mucosal stenosis at the ostium. Endoscopic, endonasal, or transnasal dacryocystorhinostomy. Pdf clinical evaluation of failed endonasal dcr operations. From our population n30, 5 cases needed a revision surgery and 2 cases underwent a second revision dcr. Internal endonasal dcr involves the creation of a large ostium with or without the endoscope, and with or without construction of nasal and lacrimal sac mucosal flaps. Endoscopic or endonasal dcr is a surgery to correct excessive tearing. The aim of study is to evaluate the endoscopic dacryocystorhinostomy dcr with conventional instruments, its results and advantage over external dacryocystorhinostomy dcr. Pooled results showed that both surgical approaches had similar success rates endoscopic endonasal dcr 82. Mechanical endonasal dacryocystorhinostomy with mucosal. Endonasal dcr surgeries endoscopic endonasal dcr or dacryocystorhinostomy is the operation of choice for watering eyes from tear duct narrowing or full obstruction. University of dundee mucosal and lacrimal flaps for endonasal. The reported success rates of endonasal dcr vary from 54 to 96 % 8, 9 and in general are lower than that of external approach performed by many ophthalmologists.
Surgical outcomes of endoscopic dacryocystorhinostomy. All the operations involved a joint approach involving a. 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. Feb 16, 2015 caldwell, west and mosher replaced endonasal dcr in early 1900 5, 6, 7.
Endonasal dcr or from the skin between your eye and nose. Clinical trial to compare success rate of endonasal. 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. This is a new technique that involves creation of a large rhinostomy and mucosal flaps. Its anatomic success rate 91% or 40 of 44 dcrs compares favorably with the success rate of other techniques for endonasal dcr and is also similar to the success of external dcr. Endoscopic visualization of fluorescein dye in the nasal cavity. A large medial turbinate, nasal polyps, granular inflammed mucosa, tight nostrils, and septal deviations are all potential problems that can make endonasal dcr more difficult or impossible. Successful external dcr creates a 24mm ostium on average regardless of bony osteotomy size bumsted, arch otolaryngol 1982. Mechanical endonasal dacryocystorhinostomy with mucosal flaps. Analysis of 104 cases of endonasal dacryocystorhinostomy in a. This new technique of endonasal dcr involves creation of a large ostium and construction of nasal and lacrimal sac mucosal flaps. Of endonasal endoscopic dacryocystorhinostomy is a work done by.
The tear sac can be reached from inside the nose endonasal dcr or from the skin between your eye and nose. The success rate of endonasal dcr was 98% in 117 cases 2, issue 2, february, 2015. To compare success rates of external dacryocystorhinostomy dcr and endoscopic endonasal dcr for acquired nasolacrimal duct. Dacryocystorhinostomy, endoscopy, endo injury to the discrete fistula site without disruption of nasal, co2 laser, silicone tubing the medial canthal anatomy and function 9,10,12. The success rate of external dcr has improved to the. 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. Repeat endonasal dcr with or without mitomycin c can be considered. A prospective series of 104 consecutive endonasal dcrs performed from january 1999 to. Simple bone removal technique in endonasal dcrendoscopic dcr. Endonasal dcr is a successful intervention with demonstrable health benefits to the patient. They are similar operations with similar success rates.
Published success rates for external dcr, endonasal dcr and endocanalicular laser dcr range widely from 50% to 99%. His group also found the nasal approach more rapid and more acceptable to patients who had an alternative technique used on the other side. Endonasal dcr can be performed with the help of rigid endoscopes or under binocular operating microscopes. Figure 2 highlights the sites of location of surgical landmarks of. Endoscopic intra nasal approach to bypass the obstruction of lacrimal apparatus is a simple and commonly practiced surgery among the ent surgeons. External versus endonasal dacryocystorhinostomy in a. The anatomy and technique of endo dcr in general is explored in more detail in. A square mucosal flap above 810 mm to the operculum of middle turbinate was incised by a blade figure 1a. Endonasal dacryocystorhinostomy with mucosal flaps. The search was limited to english language articles and the following key words were used.
Mechanical endonasal dcr which has 95% anatomical success and similar to external dcr involves creation of a large ostium is an improvement on the endonasal technique. The reported success rates of dnadependant rna synthesis with mitomycin c varied between 77. Endoscopic dacryocystorhinostomy dcr surgical technique hisham wasl, darlene lubbe endoscopic dacryocystorhinostomy dcr is a surgical intervention for epiphora caused by obstruction of the nasolacrimal duct. Over the past 25 years, there has been renewed interest in the transnasal approach to dacryocystorhinostomy dcr with many variations in surgical technique. Oct 25, 2017 the main advantages of an endonasal approach dcr include the absence of a visible scar, minimal postoperative morbidity, faster recovery and comparable success rates to that of external dcr. Endonasal intubation and endonasal dcr are effective procedures, and play an important role in the management of childhood epiphora. Intraoperative mitomycinc as adjuvant therapy in external. Endoscopic dacryocystorhinostomy with conventional. Physical examination showed a noninflammatory, subcutaneous, immobile mass below the level of the medial canthal tendon. Materials and in a prospective, nonrandomized interventional case series. Nonendoscopic endonasal dacryocystorhinostomy springerlink. Dec 15, 2016 all en dcr surgeries will be performed by a single ophthalmic plastic surgeon expert in endoscopic surgery f.
Prospective randomized comparison of mitomycin c application. This video describes the surgery, endoscopic dcr, done for chronic dacryocystitis. Reported complications of endonasal dcr do not generally appear to be greater in frequency or magnitude than those associated with external dcr. This study was done to assess the efficacy of powered endoscopic dacryocystorhinostomy dcr with creation of a large bony ostium exposing fundus of the sac and primary mucosal anastomosis. Pdf endoscopic endonasal dacryocystorhinostomy an upcoming. Dec 01, 2001 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. Endonasal dcr is a safe and effective procedure in children indicated only when the. In young children, smaller spaces and relatively larger inferior turbinates may limit the size of the telescope and other instruments, which can result in a more technically challenging procedure. This heals up very quickly and is rarely visible when healing is complete. 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. There was no history of dacryocystitis, bloody tears, midfacial trauma or surgery. Results of nonendoscopic endonasal dacryocystorhinostomy.
His dacryocystorhinostomy through an endonasal approach evaded popularity because of. Endonasal dacryocystorhinostomy ota american academy of. Patient information adnexal dacryocystorhinostomy dcr. Endoscopic dacryocystorhinostomy oculoplastic eyelid. Dcr and endoscopic endonasal dcr, often referred to as endodcr. The endoscopic approach has several advantages, including the following. Nonendoscopic mechanical endonasal dacryocystorhinostomy. Dacryocystorhinostomy an overview sciencedirect topics. Endonasal dacryocystorhinostomy dcr is a wellestablished treatment method in patients with nasolacrimal duct obstruction. Original contribution rhinology, 47, 310315, 2009 mechanical endonasal dacryocystorhinostomy a reproducible technique neil c. Ext 96 2324 endo 91 1011 15 complications external. Questionnaire responses revealed that 4894 51% patients had one or more sinus symptoms prior to dcr surgery. Pdf on dec 10, 2018, balwant singh gendeh published.
Dacryocystorhinostomy for the treatment of nasolacrimal duct. Optimising success in endoscopic revision surgery for failed. Management of childhood epiphora british journal of. Feb, 2015 we use a standard endoscopic dcr technique with an endonasal approach using 2. The third study reported that nonlaser endonasal dcr was superior to external dcr 84% vs. Limited data suggest that laser endonasal dcr may be less effective than external dcr. To describe and assess the efficacy of mechanical endonasal dacryocystorhinostomy mendcr. Time taken to do external and endoscopic endonasal.
Endoscopic dacryocystorhinostomy videos oculoplastic. Various modifications in the form of usage of micro drill, application of mitomycin c and preserving. Endoscopy dacryocystorhinostomy has many advantages over external approach. Endonasal dacryocystorhinostomy dcr has been widely used to treat nasolacrimal duct obstruction. Dcr involves opening up your existing tear sac and connecting it directly into the nose to form a new tear drainage pathway. Jan 12, 2021 the purpose of this study is to compare the success rates of endoscopic endonasal dacryocystorhinostomy en dcr and external dcr ex dcr for the treatment of primary acquired nasolacrimal duct obstruction panldo. Careful evaluation of the nasal cavity using an endoscope is crucial to assess the nasal access to the lacrimal sac. Using a 0 degree 4mm endonasal endoscope nasal mucoperiosteum in the area of the lacrimal sac will be incised and elevated. Endoscopic endonasal dcr plays an established role in revision dcr surgery.
The endonasal approach is used for the obstructed lower system. Endcr represents a safe and effective treatment for children with. Idiopathic acquired dacryocystocele treated with endonasal. A temporally defined retrospective study of 70 children 92 eyes undergoing surgery for persistent epiphora, despite two previous technically successful probing procedures. Success equal to or better than published standards. Lacrimal irrigation demonstrated blockage at the nasolacrimal duct. A longitudinal cohort study included a control group of agematched external dcr patients who were compared with a study group of endonasal dcr patients.
In our study, we under took bone removal with kerrisons 2 mm punch. This video demonstrates a simplified bone removal technique in endoscopic endonasal dcr without powered instrumentation. The study involved a prospective nonrandomised interventional case series with short perioperative follow up. 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. External dcr the operation takes place through a 10 15mm incision in the side of your nose, where a pair of glasses would rest. External dacryocystorhinostomy dcr is the most common and wellknown surgical method to restore the nasolacrimal system. Operative and postoperative data were prospectively collected on 42 patients 15 men and. The remainder of the studies did not find statistically significant differences in success rates between the 2 techniques.
Endoscopic dacryocystorhinostomy oculoplastic eyelid orbit. Surgical scarring on the face and disrupted anatomy in the medial canthal area following external dacryocystorhinostomy dcr can be avoided by an endonasal approach. The advantages and disadvantages of endonasal versus external dcr are listed in table 1. We found that 14 46,7% patients had comorbidities, including concomitant sinonasal pathology was present in 12 40%. The functional success rate of endoscopic endonasal dcr reached 93. We report on our experience of fifteen endoscopic revision dcr surgeries in fourteen patients eight female, six male with previous failed endonasal, endolaser or external dcr presenting. Bilateral endonasal endoscopic dcr was performed in 5 patients, with a total of 35 primary dcrs in our group. To compare success rates of external dacryocystorhinostomy dcr and endoscopic endonasal dcr for acquired nasolacrimal duct obstruction nldo. An endoscopic endonasal approach to dacryocystectomy. A literature search was conducted in the pubmed database in march 2016 and updated in october 2017 and february 2019. To describe the technique of nonendoscopic endonasal dacryocystorhinostomy nen dcr, and its indications and results.
Endonasal laser dacryocystorhinostomymedium term results. The main advantages of endonasal dcr include the absence of a visible scar, minimal postoperative morbidity, faster recovery, and success rates 90% comparable to that of ext dcr. A comparison of endonasal dacryocystorhinostomy and. A comparative study of external and endoscopic endonasal. Endonasal, endoscopic, dacryocystorhinostomy, dcr, mucosal flaps. Disadvantages of external dcr include potential for visible scar caused by the skin incision and possible longer healing time compared with the internal approach. Since totis original description of dcr in 1904, external approach has been used for relief of the lacrimal obstruction 1. Mar 30, 2017 all subjects underwent primary endonasal dcr and all patients underwent the same postoperative regimen. Nair1 1 royal hampshire county hospital, winchester, united kingdom 2 department of surgeryotolaryngology, head and neck surgery, the university of adelaide, adelaide, south australia summary background. This included three patients with postoperative hemorrhage two who had endonasal dcr surgery and one having external dcr surgery.
The effectiveness of simultaneous lateral tarsal strip with endonasal dacryocystorhinostomy for the treatment of nasolacrimal duct. Methods the study group comprised of 127 patients who underwent consecutive endoscopic dacryocystorhinostomy. Objectives to study the outcome of endonasal endoscopic dacryocystorhinostomy dcr with or without mucosal fl ap preservation, without mitomycin local application, sili. Endonasal dacryocystorhinostomy in wegener granulomatosis. Abnormal tearing or epiphora watery eyes takes place due to obstruction in. During recent years endonasal dcr was developed as an alternative surgical technique. The study involved prospective interventional case series with short perioperative follow up. Of course, avoiding the cutaneous approach eliminates the risk of scarring, but there are. 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. Underneath, the maxilla and frontal process of the maxilla were thinned by a power burr figure 1b and then removed by a kerrison rongeur figure 1c, to expose the entire medial wall of the lacrimal sac. A comparison of endonasal dacryocystorhinostomy with and. Endonasal dcr had gained increasing popularity and acceptance in the last decade for the treatment of primary figure 1. Complication rates were low in both types of surgery. The control group was comprised of patients with primary acquired nldo who underwent ex dcr or en dcr without the use of mmc.
In contrast, there was no statistically significant correlation between use of icg gel and anatomic success rate of endoscopic endonasal dcr. The success rate was 91% for the external dcr group in both reports and 63% and 75% for the endonasal dcr groups, defined by patency to irrigation. However, it also found that the rate of sympto m relief was similar in both groups. In addition to these, there are certain advantages of nonendoscopic endonasal approach in comparison to endoscopic approaches. The authors alone are responsible for the content and writing of the paper. With the introduction of endoscopes and dcr burrs, the endonasal approach is being used more and more by ent surgeons for management. However, there are a few reports about the overall. This prospective study was done ta compare the results of external and endonasal dacryocystorhinostomy dcr. Tenweek post dcr followup questionnaires were obtained from 7794 82% patients. Our results in the endonasal dcr group are comparable to the studies of camara 2000 and dolmetsch 2010. Tsirbas and wormald performed septoplasty and 10 fess surgery for 44 endonasal dcr. External dcr endonasal dcr surgical time min 56 48 symptomatic relief score out of 4 3.
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