Comparison of different surgical methods in endonasal dacryocystorhinostomy

Abstract

Objective: The objective of this study is to compare three different techniques applied during dacryocystorhinostomy in terms of recurrence and operative times. Methods: Operative times and follow-up results of the patients who underwent endoscopic dacryocystorhinostomy surgery between January 2011 and April 2014 due to nasolacrimal duct occlusion were compared. Lacrimal sacs of the patients in Group 1 (n=15) were explored using gouge hammer and surrounding bony structures were dilated with diamond drilling instrument. Lacrimal sacs of the patients in Group 2 (n=11) were identified and dilated using Diamond drill. Lacrimal sacs of the patients in Group 3 (n=15), were found with the aid of a gouge hammer and enlarged using Smith-Kerrison punch forceps. Results: There was no significant difference between Groups 1 and 2 as for recurrence rates. However, recurrence rates in Group 3 were found to be higher compared to Groups 1 and 2. Operative times demonstrated significant differences among 3 groups, with at its highest and lowest operative times detected in Groups 1 and 2, respectively. Conclusion: With this study, it was concluded that exploration and identification of lacrimal sac using gouge hammer and expansion of the surrounding bony structure with diamond tipped drills during dacryocystorhinostomy is an improved method with relative shortness of the operative time and lower recurrence rates.

Keywords

• Nasolacrimal canal, dacryocystorhinostomy, epiphora, dacryocystitis

Endonazal dakriyosistorinostomide farklı cerrahi yöntemlerin karşılaştırılması

Öz

Amaç: Bu çalışmanın amacı, dakriyosistorinostomi cerrahisi sırasında uygulanan üç farklı tekniğin nüks ve süre açısından karşılaştırılmasıdır. Yöntem: Ocak 2011 - Nisan 2014 tarihleri arasında nazolakrimal kanal tıkanıklığı nedeniyle endoskopik dakriyosistorinostomi cerrahisi uygulanan hastaların cerrahi süreleri ve takip sonuçları karşılaştırıldı. Grup 1'deki hastaların (n=15) lakrimal kesesi guj-çekiç ile bulunup, etrafındaki kemik doku elmas tur ile genişletildi. Grup 2'deki hastaların (n=11) lakrimal kesesi sadece elmas tur ile bulunup genişletildi. Grup 3'teki hastaların (n=15) lakrimal keseleri guj-çekiç yardımıyla bulundu ve Smith-Kerrison punch forceps ile genişletildi. Bulgular: Nüks açısından Grup 1 ve Grup 2 arasında anlamlı farklılık yoktu. Buna karşılık Grup 3'teki nüks oranı, Grup 1 ve Grup 2'ye kıyasla anlamlı olarak daha yüksek bulundu. Ameliyat süresi her üç grupta da anlamlı farklılık gösterdi ve Grup 2'de en yüksek, Grup 3'te ise en düşük değerde idi. Sonuç: Bu çalışma, dakriyosistorinostomi cerrahisi sırasında lakrimal kesenin guj-çekiç ile bulunup, etrafındaki kemik dokunun elmas tur ile genişletildiği yöntemin cerrahi süresinin nispeten kısa olması yanında düşük nüks oranlarıyla iyi bir yöntem olduğu sonucuna ulaşılmıştır.

Anahtar Kelimeler

• Nazolakrimal kanal, dakriyosistorinostomi, epifora, dakriyosistit

Kaynakça

1. Francis IC, Stapleton F, Wilcsek G. Symptom assessment in patients with functional and primary acquired nasolacrimal duct obstruction before and after successful dacryocystorhinostomy surgery: a prospective study. Br J Ophthalmol 2007;91:1671–4.
2. Savino G, Battendieri R, Traina S. External vs endonasal dacriy- ocystorhinostomy:has the current view changed? Acta Otorhino- laryngologica Italica 2014;34:29–35.
3. Duggal P, Chakravorty S, Azad RK, Mohan C. An epidemiologi- cal study on patients undergoing dacryocystorhinostomy. Indian J Otolaryngol Head Neck Surg 2006;58:349–51.
4. Berlucchi M, Tomenzoli D, Trimarchi M, Lombardi D, Battaglia G, Nicolai P. Dacryocystocele in the adult: etiology, diagnosis and treatment. [Article in Italian] Acta Otorhinolaryngologica Italica 2001;21:100–4.
5. Liang J, Hur K, Merbs SL, Lane AP. Surgical and anatomic con- siderations in endoscopic revision of failed external dacryocys- torhinostomy. Otolaryngol Head and Neck Surg 2014;150:901–5.
6. Gauba V. External versus endonasal dacriyocystorhinstomy in a specialized lacrimal surgery center. Saudi J Ophthalmol 2014;28: 36–9.
7. Lieberman SM, Casiano RR. Is an endoscopic approach superior to external dacryocystorhinostomy for nasolacrimal obstruction? Laryngoscope 2015;125:2–4.
8. McDonough M, Meiring JH. Endoscopic transnasal dacryocys- torhinostomy. J Laryngol Otol 1989;103:585–7.

9. Hartikainen J, Antila J, Varpula M, Puukka P, Seppa H, Grenman R. Prospective randomized comparison of endonasal endoscopic dacryocystorhinostomy and external dacryocystorhinostomy. Laryngoscope 1998;108:1861–6.
10. Dolman PJ. Comparison of external dacryocystorhinostomy with nonlaser endonasal dacryocystorhinostomy. Ophthalmology 2003;110:78–84.
11. Ben Simon GJ, Joseph J, Lee S, Schwarcz RM, McCann JD, Goldberg RA. External versus endoscopic dacryocystorinostomy for acquired nasolacrimal duct obstruction in a tertiary referral center. Ophtalmology 2005;112:1463–8.
12. Hull S, Lalchan S, Olver JM. Success rates in powered endonasal revision surgery for faild dacryocystorhinostomy in a tertiary refer- al center. Ophthal Plast Reconstr Surg 2013;29:267–71.
13. Talks SJ, Hopkisson B. The frequency of entry into an ethmoidal sinus when performing a dacryocystorhinstomy. Eye 1996;10: 742–3.
14. Metson R. The endoscopic approach for revision dacryocystorhi- nostomy. Laryngoscope 1990;100:1344–7.
15. Majumder A, Singh M, Das C, Das S, Hazra T. Endonasal dacry- ocystorhinostomy with mucosalflaps: our experience. Indian J Otolaryngol Head Neck Surg 2013;65:371–5.
16. Tsirbas A, Wormald PJ. Endonasal dacryocstorhinostomy with mucosal flap. Am J Opthalmol 2003;135:76–83.
17. Sonkhya N, Mishra P. Endoscopic transnasal dacryocystorhinos- tomy with nasal mucosal and posterior lacrimal sac flap. J Laryngol Otol 2009;123:320–6.
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21. Please cite this article as: Ulusoy S, Erden M, Yüksel H, Ça¤lar E, Dinç ME, Dalgıç A. Comparison of different surgical methods in endonasal dacry
22. ocystorhinostomy. ENT Updates 2015;5(1):30–34.