Endonasal endoscopic dcr is a viable alternative to external dcr, coexisting sinonasal diseases can be managed simultaneously, as may. The endonasal approach offers certain advantages such as the absence of an external scar, lower complication rate, shorter operative time and complete preservation of the pump function by avoiding any manipulation of the orbicularis oculi. Results could prove useful in understanding the role of the lacrimal pump after dcr and associated differences between the external and the endonasal approaches. A freer 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. Most commonly, this is caused by scarring along the new passage.
An experts view shrikant deshpande, anjaneya agashe, abhinav loomba, neha dhiware department of ophthalmology, mahatma gandhi mission medical college, navi mumbai, maharashtra, india. Just before joining the sac, there is a dilation of the canaliculus. Both kerrison punch and drill are widely used in endoscopic dcr with nonconclusive knowledge about. Approximately 46% of cases 48 of 104 required a septoplasty at the time of surgery which is higher than other studies of endonasal dcr, but the creation of a large ostium necessitates better access than is often required with other procedures. Fifty patients who underwent ext or enddcr between january 20102012 were involved in the study. We merged the data of two of the studies by hartikainen et al. The light from the probe is visualized in the nose through a rigid nasal scope. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. The endonasal dcr technique uses a fberoptic probe inserted in the punctum for guidance. Dcr, or dacryocystorhynostomy, is a surgery performed to create a new tear drain between the eye and nose when your current tear drain becomes blocked or obstructed. Average duration of the surgical procedure of dcr was 18 min. Endonasal microrhinoscopic analysis of dcr failure narender k. Caldwell 1 and toti 2, respectively, described the endonasal and external approaches to dacryocystorhinostomy dcr 1, 2.
Postoperative observations included slit lamp, fluorescein dye disappearance test, lacrimal syringing, lacrimal endoscopy, and nasal endoscopy. A dacryocystorhinostomy dcr procedure aims to restore drainage of tears by bypassing a blockage in the nasolacrimal. Pdf to describe and assess the efficacy of mechanical endonasal dacryocystorhinostomy mendcr. Mechanical endonasal dacryocystorhinostomy with mucosal flaps. Nonendoscopic endonasal dacryocystorhinostomy springerlink. Expanded endonasal approach how is expanded endonasal. External versus endonasal dacryocystorhinostomy in a. Some studies anatomic identification of the sac and mucosal lining, because the inside of the sac may not always visible in endoscopic surgery. The spiway is the first and only access guide for endoscopic endonasal skull base surgery. Methods this is a retrospective, nonrandomized case. The disadvantages of endonasal dcr include a relatively smaller opening between the lacrimal sac and nasal cavity, high equipment cost and steep learning curve and some of these disadvantages are known to influence the success rate. The tear sac can be reached from inside the nose endonasal dcr or from the skin between your eye and nose. Our study indicated that both endonasal and external dcr can lead to.
Endonasal endoscopic dcr and externaldcr in primary. Tears generated by the tear glands in your eyes need to be drained to the nose. 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. Endonasal correction works at the same level on which the problem was created. To compare success rates of external dacryocystorhinostomy dcr and endoscopic endonasal dcr for acquired nasolacrimal duct. Endonasal cranial correction advanced biostructural. Pdf mechanical endonasal dacryocystorhinostomy with mucosal. 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.
Endoscopic dacryocystorhinostomy dcr surgical technique vula. External dcr is better if the tiny tear ducts in the eyelids canaliculi are blocked as well as the bigger duct in the nose. Efficacy of endo nasal dcr in primary nasolacrimal duct obstruction. This potentially leads to cleaner surgical fields and improved surgical efficiency. These informations are needful to understand and improve endonasal dcr and may help the oculoplastic surgeon experience a smoother transition when moving from the external to. 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. Local and systemic safety of intranasal corticosteroids.
That means that every part of the body functions in a synchronized fashion. Physical forces on the skull invariably come from outsidein. On average, this happens to one out of 20 patients with nasolacrimal duct obstruction. In the expanded endonasal approach to the ventral skull base. Endonasal cranial correction by abc is truly a paradigm shift in the physical medicine field. Mri evaluation of lacrimal drainage after external and. This relatively new development on the traditional technique of external dcr represents an increasingly common skillset in rhinologic practice. Conventional dacryocystorhinostomy versus endonasal. Endoscopic dacryocystorhinostomy oculoplastic eyelid. The success rates for endonasal dacryocystorhinostomy. Outcomes of endoscopic endonasal dacryocystorhinostomy for. Endonasal endoscopic dcr and externaldcr in primary nasolacrimal duct obstruction the safety and scientific validity of this study is the responsibility of the study sponsor and investigators.
Sharma the initial application of operating microscope to nasal sur gery was limited to the creations of antrostomies in children and adults 1. Dacrocystorhinostomy dcr is an operation used to treat nasolacrimal duct obstruction. Learning curve is stiff due to requirement of few adjunct procedures. Endonasal dcr was first completed in 1958 with the use of a microscope, and later the procedure used endoscope systems and lasers. Exdcr was first described by toti in 1904 and is the most widely practiced procedure. The basic indication is same in all cases and either route can be used. There were no complications intraoperatively as well as in. Diverticula of the lacrimal sac may be present which can cause persistentt infection leading to. Endonasal dcr accomplishes the same task, but accesses the lacrimal sac through the nasal cavity. Especially, the joining incision is difficult to make deep to the bone as the blade is. Listing a study does not mean it has been evaluated by the u. Efficacy of endo nasal dcr in primary nasolacrimal duct.
Jedmed has a full line of instrumentation for the endonasal dcr procedure. Despite the advantages, the general impression is that endonasal dcr has a lower success rate than external dcr. Twelve patients with dacryocystitis and canalicular obstruction underwent a conventional endoscopic endonasal dacryocystorhinostomy eedcr combined with a modified canalicular repair. Endonasal dacryocystorhinostomy dcr was first proposed by caldwell. Endoscopic dcr is also technically more difficult to learn, and the learning curve for the endoscopic procedure has been reported in several studies. To compare the success and complication rates, duration of surgeries and clinical comfort after endoscopic dacryocystorhinostomy enddcr or external dacryocystorhinostomy extdcr.
Totally 56 eyes of 46 patients with prolonged epiphora underwent minimally invasive endoscopic endonasal dcr. You may also be prescribed antibiotic tablets or capsules. The average success rate of endonasal dcr with unciformectomy was 97. Endoscopic or endonasal dcr is a surgery to correct excessive tearing. Bicanalicular silicone stents in endonasal dcr american. Iennessee we willtake reasonable steps to provide freeofcharge language assistance services to people who speak languages we are likely to hear in our practice and who dont speak english well enough to talk to us about the dental care we are prwiding. We also merged the data of the papers by lester et al. The succsess rate is similar and at the same time it avoids the pitfalls of external dcr. Dacryocystorhinostomy dcr has traditionally been performed vi. Laser dcr laser dacryocystorhynostomycreating a new tear drain. Extended application of functional endoscopic sinus surgery in ophthalmology and neurosurgery carrau et al. Patients usually have the same experience with abc endonasal cranial correction ending their searches for relief. Concomitantly with dcr septoplastics in two patients and lateral lamictetomy in one patient were performed.
His dacryocystorhinostomy through an endonasal approach evaded. An instructional video on the surgical technique of an endonasal dacryocystorhinostomy dcr. A comparative study rajeev reddy1, prajwalli reddy2 1associate professor, department of ent, kbn medical college, kalaburagi, karnataka, india, 2assistant professor, department of ophthalmology, mr medical college, kalaburagi, karnataka, india females are affected more than males, probably due to. They found a higher rate of success in the stent surgeries. 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.
Nasal sprays may also be prescribed, and instructions about their use will be provided. Results of endonasal or external approach for dcr became comparable 3. Endonasal dacryocystorhinostomy ota american academy of. The spiway is designed to help reduce mucosal trauma and keep the scope clean. This document describes endonasal dacryocystorhinostomy dcr and examines the evidence to answer key questions about the effectiveness of the procedure compared with external dcr. Endoscopic endonasal dcr is a valid alternative to external dcr. The technique described for endoscopic dacryocystorhinostomy. This video demonstrates endoscopic dcr performed on a 57yearold female.
For bone removal, kerrisons punch and dcr burr was used. Pdf endonasal versus external dacryocystorhinostomy for. Dcr surgery can fail when an obstruction to the free drainage of tears recurs. This included three patients with postoperative hemorrhage two who had endonasal dcr surgery and one having external dcr surgery. Instructions following endonasal dcr surgery other medications pg2 eye drops, if prescribed, are instilled into the eye 3 times a day. Endoscopic vs external dacryocystorhinostomycomparison. 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. Endonasal dcr has comparable success rates with external dcr and. Article information, pdf download for comparison between endoscopic and external. All instruments are handcrafted using the finest german quality stainless steel.
Transnasal endoscopic and combined intraextranasal approach for the surgical treatment of frontal sinus cerebrospinal fluid rhinorrhea qintai yang, peng li, jiancong huang, weihao wang, shanyan bian, xuekun huang, xian liu, gehua zhang department of otolaryngologyhead and neck surgery, the third affiliated hospital of sun yatsen university, guangzhou, peoples republic of china abstract. This requires removal of the small amount of bone that lies between your tear sac and your nose. Pdf the endonasal surgical approach of the lacrymal sac assisted by videoendoscopy is carried out today with high success rates. While nasal tip recontouring through the endonasal complete release approach is shown to generate excellent cosmetic and functional results in the present context and patient population, we do not think that these data should be used to reheat the debate between proponents of the open and the endonasal approach.
Results of endoscopic endonasal dacryocystorhinostomy. 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. Reported complications of endonasal dcr do not generally appear to be greater in frequency or magnitude than those associated with external dcr. It can be done with external ex or endonasal en access. 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. Our experience microscope to identify the punctum in these cases. This alternative route is generated using an external approach external dcr or through the nasal cavity using an endoscope eesdcr. Endonasal dacryocystorhinostomy is considered to be the standard treatment for chronic dacryocystitis, and is simple to perform and is very effective even in patients with complications like abscess, fistula periorbital cellulitis. The files of 165 patients who underwent endonasal dcr at a tertiary referral centre between 1991 and 2001 were retrospectively assessed. Transnasal endoscopic and combined intraextranasal. I have three comments that i hope will help readers who are less familiar with endonasal lacrimal surgery, put. Longterm results of endonasal dacryocystorhinostomy. However, it is difficult to compare the success rate for primary surgery between external dcr and endoscopic endonasal procedures, as there are few comparative studies. This is a new technique that involves creation of a.
Our aim was to evaluate the clinical results of endoscopic endonasal surgical dacryocystorhinostomy eesdcr as team work by an ophthalmologist and an. Dcr involves opening up your existing tear sac and connecting it directly into the nose to form a new tear drainage pathway. The human body is a single synchronized functioning unit. Endonasal endoscopic dcr is the best at present treatment of dcr. Abnormal tearing or epiphora watery eyes takes place due to obstruction in. A successful surgical outcome was defined as a significant improvement in symptoms, adequate water passage from the puncta to the nasal cavity, and patency of the dcr ostium. Tsirbas and wormald are to be congratulated on their landmark paper in lacrimal surgery describing endonasal dacryocystorhinostomy dcr with mucosal flaps, 1 which is also known as powered endonasal dcr. The endonasal dcr technique uses a fiberoptic probe inserted in the punctum for guidance. The plugin will add command line options to nosetests. Understanding endonasal anatomy, wide endoscopic marsupialisation of the lacrimal sac, and meticulous care of the nasal mucosa are important to achieve. A questionnaire was applied to patients preoperatively, and postoperatively. Primary external dacryocystorhinostomy versus primary endonasal. Endoscopic endonasal dacryocystorhinostomy combined with.
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