Objectives to describe powered endoscopic dacryocystorhinostomy dcr with full sac exposure and. Caldwell first described the endonasal approach in 1893 18. The powered endoscopic dcr technique was previously described. Endoscopic dacryocystorhinostomy med j malaysia vol 63 no 2 june 2008 145 the role of edcr is not to replace the conventional dcr, but to enhance and provide an alternative approach for the. Endoscopic dacryocystorhinostomy oculoplastic eyelid.
The medial wall of the sac is incised or excised, facilitating drainage of tears into the nasal cavity. 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. Introduction bilateral simultaneous endoscopic dacryocystorhinostomy endodcr has received little attention in the. It explores the use of different decongesting and vasoconstricting preparations and the technique of placing them in the nasal cavity we. In 90% of people, the two canaliculi join to make a common canaliculus before entering the lacrimal sac. Endoscopic dcr endoscopic dcr is a minimally invasive procedure to unblock tear ducts. Endoscopic dacryocystorhinostomy 47 the authors in their series of over one thousand consecutiv e endoscopic dcrs found that the best technique for achieving consistently good reliable results was the removal of the medial wall of the lacrimal sac allowing it to heal in. Endoscopic dacryocystorhinostomy article pdf available in vojnosanitetski pregled. The diagnosis is clinical, so a thorough clinical history and physical. No impact of nasal septoplasty on the outcome of endoscopic. Combined subciliary and endoscopic dacryocystorhinostomy a novel approach 1 rajesh. February 2005 to order copies copies of this booklet can be ordered from the department of health publications order line. Eedcr is a highly rewarding endoscopic procedure for management of dacryocystitis when epiphora does not respond to medications or repeated syringing of nasolacrimal duct. An endoscopic endonasal approach to dacryocystectomy.
No matter where you are in your career, we would welcome you and encourage you to consider joining our community. Nldo is common, and presenting symptoms include epiphora and dacryocystitis infection. Endoscopic dcr n20 difficult sac localization25% recurrence of epiphora 10% synechiae 5% how to cite this article. In particular, combining endcr with lacrimal ct scan provides advantages over traditional lacrimal surgery. This study aims to assess the efficacy and safety of nasal endoscopic dacryocystorhinostomy ned for patients with chronic dacryocystitis cd. Javate papers on endoscopic radiofrequency assisted dacryocystorhinostomy eradcr and endoscopic lacrimal duct recanalization eldr published in both the journal of surgical technique in ophthalmic plastic and journal of reconstructive surgery and ophthalmic plastic reconstructive surgery. Thirtyfive patients were included in this study, and selection of patients was done depending on both clinical findings preoperatively and on the operative findings during surgery. These results are similar to those achieved with external dcr8,9. Experience at sheikh zayed hospital, lahore introduction. Surgery remains the only effective treatment, when other measures, such as unblocking through probes or a.
Understanding endonasal anatomy, wide endoscopic marsupialisation of the lacrimal sac, and meticulous care of the. Endoscopic dcr is minimally invasive and efficaceous procedure for nasolacrymal obstructions performed by otorhinolaryngologist and ophtalmologist. The purpose of this study was to compare the longterm surgical outcome in endonasal dacryocystorhinostomy dcr with and without silicon stent placement. It is a simple, less time consuming, safe but skilful, highly satisfying surgery both for.
Although within the early literature, the reported success rate of external dcr was slightly higher than internal endoscopic, later studies have shown comparable rates of success. Endoscopic dacryocystorhinostomy 47 the authors in their series of over one thousand consecutiv e endoscopic dcrs found that the best technique for achieving consistently good reliable results was the removal of the medial wall of the lacrimal sac allowing it to heal in close conjunction with the mucosa of the nasal cavity. This video demonstrates an endoscopic dacryocystorhinotomy dcr. This study aims to describe our surgical technique and results for endoscopic transnasal. Yadav 1 ameya asarkar 2 girish surlikar 3 dhond 1 rajawadi municipal hospital, ghatkopar, mumbai 2 private consultant 3 bhagwati general hospital, borivili abstract introduction. This study aimed to evaluate longterm results of external dacryocystorhinostomy dcr at a tertiary eye care center specializing in lacrimal duct surgery in germany. Bilateral simultaneous endoscopic dacryocystorhinostomy. Patients develop symptoms of tearing when there is an imbalance between tear produc tion and drainage function of lacrimal sys tem. 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. Dacryocystorhinostomy dcr is indicated in patients with significant epiphora and complete or nearcomplete nasolacrimal duct obstruction as diagnosed by punctal irrigation. The endoscopic surgical dcr used by the authors was designed to combine the benefits of external and endoscopic dcr. External versus endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction in a tertiary referral center. The lacrimal sac is placed in an ovalshaped fossa measuring 15 mm in. Dcr can be achieved through an external or internal endoscopic endonasal approach.
The technique described for endoscopic dacryocystorhinostomy dcr allows complete exposure of the lacrimal sac after creation of a large bony ostium. Endoscopic surgery of the orbit and related structures 7 endoscopic dacryocystorhinostomy dcr endoscopic dacryocystorhinostomy dcr is indicated for patients with lacrimal sac obstruction or nasolacrimal duct obstruction nldo. Penttila e, smirnov g, seppa j, tuomilehto h, kokki h. It is a retrospective analysis of cases of endoscopic dacryocystorhinostomy dcr in whom stents were not inserted after completion of surgery for the last 2 years.
External dacryocystorhinostomy was described in early 20th century. Pediatric endonasal endoscopic dacryocystorhinostomy is a safe and effective procedure to correct nasolacrimal system obstruction in cases that are unresponsive to conservative treatments. Endoscopic dacryocystorhinostomy dcr is a surgical intervention for epiphora caused by obstruction of the nasolacrimal duct. Understanding endonasal anatomy, wide endoscopic marsupialisation of the lacrimal sac, and meticulous care of the nasal mucosa are important to achieve good results. A large study that compared the use of lasers with electrocautery instruments for endoscopic dcr in 398 patients reported success rates of 92% 222242 and 90% 2831 using two different laser types, and 87% 3945 for endoscopic dacryocystorhinostomy ipg1. Ipg 1 endoscopic dacryocystorhinostomy information for. The following 7 electronic databases will be searched from inception to the present. Symptombased presentation of chronic rhinosinusitis and symptomspecific outcomes after endoscopic sinus surgery. Basic technique and keys to success learning objective upon completion, participants should be able to. Access is through your nose, using a small thin camera endoscope. Endoscopic cold steel versus laser dacryocystorhinostomy.
Powered endoscopic dacryocystorhinostomy with mucosal. With the advent of nasal endoscopes, endoscopic dacryocystorhinostomy is becoming popular. To circumvent the disadvantages of endoscopic dacryocystorhinostomy such as small rhinostomy size, high failure rate and expensive equipment, we hereby introduce a modified technique of non endoscopic mechanical endonasal dacryocystorhinostomy. Endoscopic dcr has the potential to reduce morbidity with improved hemostasis, utilization of local anaesthetics and shorter hospitalization. Endoscopic dacryocystorhinostomy videos oculoplastic. Transition from external to endonasal endoscopic dacryocystorhinostomy. The most common cause of a surgical failure in endoscopic dcr is obstruction of the neoostium by granulation tissue or synechia that forms postoperatively 511. Longterm outcomes of external dacryocystorhinostomy in. Nonendoscopic mechanical endonasal dacryocystorhinostomy. This alternative route is generated using an external approach external dcr or through the nasal cavity using an endoscope eesdcr.
After 12 months, 59% 1932 of patients were asymptomatic. Position of lacrimal sac as seen during endonasal visualization lid. Purpose comparison of surgical times for dacryocystorhinostomy dcr by three different approaches. Results of endonasal laserassisted dacryocystorhinostomy. Most previouslydescribed endoscopic dcr procedures involve a small opening at the medial wall of the lacrimal sac, and sacrifice nasal and lacrimal sac mucosa during the procedure. A prospective comparative analysis of 66 patients who underwent primary endoscopic dcr with stenting group i, revision endoscopic dcr with stenting group ii, and primary endoscopic dcr without. This narrated video demonstrates nasal preparation for endoscopic dacryocystorhinostomy dcr surgery. Endoscopic dacryocystorhinostomy dcr is a recognized procedure performed to treat epiphora caused by anatomical or functional obstruction of the nasolacrimal apparatus. Dacryocystorhinostomy dcr is the standard treatment for nasolacrimal duct obstruction1. Rates for success for endoscopic dacryocystorhinostomy dcr ranges from 70% 4 to 95%5,6,7. Endoscopic dacryocystorhinostomy pubmed central pmc. Dacryocystorhinostomy dcr has traditionally been performed vi. This retrospective study describes and evaluates the effectiveness of a modified technique of conventional endoscopic dacryocystorhinostomy dcr that minimizes the obstruction of a neoostium by creating an enlarged marsupialized lacrimal sac using mucosal flaps. Dacryocystorhinostomy an overview sciencedirect topics.
The key to the improved success rates achieved with endoscopic dcr is to attempt to replicate the external procedure as closely as. Original research article open access endoscopic dacryocystorhinostomy dcr. Dacryocystorhinostomy for the treatment of nasolacrimal. The operation is very similar to external dcr, except there is no cut through the skin and no scar afterwards. Endoscopic transnasal dacryocystorhinostomy the journal. Pdf on jan 1, 2018, pandit vk and others published to analyse the success rate of external dacryocystorhinostomy related with anatomical osteotomy size made during surgery. Endoscopic dacryocystorhinostomy understanding nice guidance information for people considering the procedure, and for the public issue date. Analysis of the results of surgical endoscopic dacryocystorhinostomy. Cochrane library, embase, medline, cumulative index to nursing and allied health literature, web of science, allied and. Dacryocystorhinostomy dcr involves the creation of an alternative route for the drainage of tears between the lacrimal sac and nasal cavity, bypassing the nasolacrimal duct. The current endoscopic dcr techniques were developed in the 1980s. Franklin lakes, nj, joining the leading edges of incisions a and c. Validation of a symptomscore questionnaire and longterm results of endoscopic dacryocystorhinostomy.
The diagnosis is clinical, so a thorough clinical history and. Endoscopic dacryocystorhinostomy to treat congenital nasolacrimal. Especially, the joining incision is difficult to make deep to the bone as the. Improving outcomes by combining septoplasty with primary external dacryocystorhinostomy. Nasolacrimal duct dysfunction has many different etiologies. Describe the basic steps of endoscopic dacryocystorhinostomy. Efficacy of nasal endoscopic dacryocystorhinostomy for. Endoscopic endonasal surgery should be considered in patients with lacrimal obstruction, due to its high success rate, besides being safe.
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