Dacryocystorhinostomy dcr is the standard procedure for the treatment of primary acquired nasolacrimal duct obstruction panldo. Endonasal endoscopic dcr has gained popularity over the years because it is an effective, easy, well tolerated procedure with the advantages of avoidance of an external scar, preservation of the lacrimal pump mechanism, and being relatively easy to perform. Nasolacrimal duct dysfunction has many different etiologies. Dcr is sometimes required for paediatric congenital or acquired nasolacrimal duct obstruction. 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. Epiphora or abnormal tearing occurs because of blockage in the lacrimal drainage system. The nasal mucosa was decongested with neuropatties soaked in a solution of 4 ml of normal. Use of silicone stent in endoscopic dcr to improve the success rate of the operation have. Thirty patients undergoing endoscopic dcr for chronic dacryocystitis were studied prospectively. The endoscopic dcr is known to have a shorter operative time and a relative lower complication rate. Endoscopic versus external approach dacryocystorhinostomy. Dec 22, 2015 dacrocystorhinostomy dcr is an operation used to treat nasolacrimal duct obstruction.
Endoscopic dcr endoscopic dcr is a minimally invasive procedure to unblock tear ducts. Oct 31, 2018 in this interesting article, our experienced colleagues describe their favoured technique for performing endoscopic dcr and share with us the key steps for a successful outcome. Compared with external dcr, endoscopic dcr is more expensive, with high equipment costs. Endoscopic dcr is usually considered for patients who have been refractory to conventional treatment such as warm compresses, massage and probing of the nasolacrimal duct. Objective to report revision external dacryocystorhinostomy redcr results following failed dacryocystorhinostomy dcr surgery. Mar 23, 2017 endoscopic dcr dacryocystorhinostomy 1. As a result, endoscopic dcr is a good alternative surgical method for external dcr surgery. Dacryocystorhinostomy dcr is the standard treatment for nasolacrimal duct obstruction1. Gender 1020231404150total year year year year male 25 27 10 08 70 female 12 09 06 03 30 total37 36 11 11 100. The operation involves removing a piece of bone from your nose to.
Endoscopy is the insertion of a long, thin tube directly into the body to observe an internal organ or tissue in detail. Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the american society of colon and rectal surgeons and society of american gastrointestinal and endoscopic surgeons. Endoscopic dacryocystorhinostomy the lead on this matter and although data in the paediatric group are not so common as in adults, endoscopic endonasal dcr is being increasingly used and offers advantages, especially in children, over external dcr with the same success rates reported in the literature. In this study we assess the success rates of endoscopic dcr with and without silicone stents. Jun 10, 2008 ocular surgery news posed the following question to a panel of experts. Surgery the powered endoscopic dcr technique was previously described. Endonasal endoscopic dacryocystorhinostomy in the paediatric. Endoscopic transnasal dacryocystorhinostomy volume 103 issue 6 m. Prevalance of lateral nasal wall pathology in association with deviated nasal septum among study subjects. Endoscopic dacryocystorhinostomy videos oculoplastic. Objectives to describe powered endoscopic dacryocystorhinostomy dcr with full sac exposure and primary mucosal anastomosis and report perioperative and followup results achieved with this.
These results are similar to those achieved with external dcr8,9. 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 nonendoscopic mechanical endonasal dacryocystorhinostomy. Is endoscopic dacryocystorhinostomy dcr the new standard for nasal lacrimal duct surgery, or. The primary and final outcomes of endoscopic and external. Endoscopic dacryocystorhinostomy with and without silicone. Endoscopic dcr has many advantages over external dcr. To compare a composite technique of endoscopic dacrocystorhinostomy with the conventional technique. Endoscopic dacryocystorhinostomy dcr can be considered a safe procedure, with an overall rate of complications that is generally low. I perform dcr through the endoscopic approach, 95% of the times. A metaanalysis of 251 external cases compared to 222 endoscopic laser dcrs favored the external approach z5. Endoscopic transnasal dacryocystorhinostomy the journal. Endoscopic dacryocystorhinostomy dcr is a recognized procedure performed to treat epiphora caused by anatomical or functional obstruction of the nasolacrimal apparatus. Agent days preoperatively dabigatran, rivaroxaban 12a nsaids aspirin 47 warfarin 5 clopidogrel 57 modified from andrew and selva 11 nsaid nonsteroidal antiinflammatory drug aprovided that glomerular filtration rate 60 mlmin despite the historic belief that aspirin needs to be discontinued 7 days before the procedure, recent data have demonstrated that 4 days is sufficient.
Dacryocystorhinostomy dcr is indicated for patients who suffer from chronic epiphora tearing from the eye onto the face or dacryocystitis infection. Jan 29, 2004 endoscopic dacryocystorhinostomy dcr is indicated when medical therapy has failed to achieve resolution of the disease. Endoscopic dacryocystorhinostomy dcr iowa head and neck. To our knowledge, this is thelargestendoscopic dcr retrospec.
Conventional septoplasty verses endoscopic septoplasty. Endoscopic dacryocystorhinostomy dcr iowa head and. The dacryocystorhinostomy operation, which involves fistulization of the lacrimal sac into the nasal cavity, may alleviate the symptoms. Endoscopic dacryocystorhinostomy blocked tear duct. External dcr 80 100% mechanical endoscopic dcr 74 100% laser endoscopic dcr 56 100% a metaanalysis was undertaken for rcts and cohorts. Endoscopic transnasal dacryocystorhinostomy the journal of. An endoscopic dacryocystorhinostomy dcr, or blocked tear duct surgery, is a minimally invasive outpatient surgical procedure that reestablishes the normal flow of tears from the eye into the nose.
Over the past 3 decades it has become common practice for surgeons to place stents or. Is endoscopic dacryocystorhinostomy dcr the new standard for nasal lacrimal duct surgery, or is the traditional external. Endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction. Ocular surgery news posed the following question to a panel of experts. Recurrent infection may also occur as a result of the stagnation. Two main advantages are quicker recovery and lack of external scar. In this interesting article, our experienced colleagues describe their favoured technique for performing endoscopic dcr and share with us the key steps for a successful outcome dacrocystorhinostomy dcr was historically performed by ophthalmologists for nasolacrimal obstruction using external techniques. The main advantages are avoidance of facial scarring, no division of the medial canthal ligament and the preservation of the pump action of the lacrimal sac of the orbicularis oculi muscle 8, 9. Advantages of endoscopic dcr no external incision better visualization of anatomy easier to supervise trainees less postoperative swelling no lacrimal pump disruption simultaneous correction of intranasal pathology higher patient acceptance eg, younger women, children american academy of ophthalmology.
Since then, endoscopy has been effectively utilized in the treatment of all conditions that involve the lacrimal drainage apparatus. A prospective study on 27 cases of chronic dacryocystitis was done to see the outcome of management by enddcr in indian population and to look for advantages or disadvantages over extdcr from available datas in literature all cases were diagnosed. Inferiorly, the inferior turbinate is demonstrated. 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. Dacryocystorhinostomy dcr is a procedure utilized for symptomatic acquired nasolacrimal duct obstruction nldo due to stenosis of the nasolacrimal duct or, less commonly, dacryoliths. Comparison of endoscopic and external dacryocystorhinostomy for. Saratziotis a, emanuelli e, gouveris h, babighian g. Mar 14, 2017 dacryocystorhinostomy dcr is indicated for patients who suffer from chronic epiphora tearing from the eye onto the face or dacryocystitis infection of the tear sac, due to nasolacrimal duct. Dec 27, 2019 there is limited evidence in literature determining age effect on outcomes of endoscopic dacryocystorhinostomy edcr in adult patients with primary acquired nasolacrimal duct obstruction nldo. If unsuccessful, revision endoscopic dcr is a good option. Basic technique and keys to success learning objective upon completion, participants should be able to.
To our knowledge, this is thelargestendoscopicdcrretrospec. Dacryocystorhinostomy dcr is a surgical procedure performed to relief nasolacrimal duct obstruction, which involves the creation of ostium at the lacrimal bone to form a shunt in the nasolacrimal pathway. Role of silicone stenting in endoscopic dacryocystorhinostomy. Pdf on dec 10, 2018, balwant singh gendeh and others published endoscopic dacryocystorhinostomy find, read and cite all the research. In general, endoscopic management of dcr failure has been shown to have excellent results, ranging from 76% to 91% success. The endoscopic surgical dcr used by the authors was designed to combine the benefits of external and endoscopic dcr. Endoscopic dacryocystorhinostomy dcr is used to treat epiphora caused by anatomic or functional obstruction of the nasolacrimal apparatus. Meiring first introduce endoscopic endonasal dcr that helped revive interest in the endoscopic technique6. Oct 18, 2011 this video depicts a revision endoscopic dacryocystorhinostomy dcr. Dacryocystorhinostomy dcr surgery can be done from external approach or endoscopic though the nose approach. Using endoscopic instruments entirely through the nose, the thin lacrimal bone is removed and the lacrimal sac is open directly into the nose.
Two approaches of dcr have been established, endoscopic and external dcr ex dcr and en dcr. The diagnosis is clinical, so a thorough clinical history and. Dacryocystorhinostomy dcr consists of creating a lacrimal drainage pathway to the nasal cavity to restore permanent drainage of previously obstructed excreting system. Epiphora, or abnormal tearing, occurs because of blockage in the lacrimal drainage system, which impairs normal tear channeling into the nose. Endoscopic dacryocystorhinostomy in functional lacrimal obstruction. As with external dcr, the lacrimal window is large enough to allow inspection of the sac for other pathology and any obstruction to the common canalicular opening can also be addressed. External dacryocystorhinostomy was described in early 20th century. Endonasal endoscopic dcr is the best at present treatment of dcr. This video demonstrates an endoscopic dacryocystorhinotomy dcr. Powered endoscopic dacryocystorhinostomy with mucosal. Factors affecting success in endoscopic dacryocystorhinostomy. Access is through your nose, using a small thin camera endoscope.
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. This operation is done to relieve excessive watering from the eye. This study evaluated the longterm results of endoscopic dacrocystorhinostomy dcr performed as a daycase procedure under local anaesthesia. The tears are usually drained into the nose through the nasolacrimal passage. Though success rates are higher with external dcr, endonasal endoscopic laser dcr offers certain advantages over the external approach while keeping the option of external dcr open, if needed at a. Clinical practice guidelines for enhanced recovery after. Endoscopic dacryocystorhinostomy dcr is used to treat patients diagnosed with lacrimal sac or nasolacrimal duct obstruction nldo. Dacrocystorhinostomy dcr was historically performed by ophthalmologists for nasolacrimal obstruction using external techniques. Endoscopic dcr is also technically more difficult to learn, and there is a definite learning curve. A dcr procedure involves removal of bone adjacent to the nasolacrimal sac and incorporating the lacrimal sac with the lateral nasal. Objective to describe the indications, technique, and results of endonasal endoscopic dacryocystorhinostomy in children with congenital and acquired disorders of the nasolacrimal system. Manuel bernalsprekelsen, isam alobid and joaquin mullol miret. Paediatric endoscopic and external dcr have similar success rates of around 8396%.
The national institute for health and clinical excellence nice has issued full guidance to the nhs in england, wales, scotland and northern ireland on endoscopic dacryocystorhinostomy. Full text views reflects the number of pdf downloads, pdfs sent to. Endoscopic dcr is an endonasal minimally invasive procedure to bypass an obstructed nasolacrimal duct by creating a. Endoscopic endonasal surgery should be considered in patients with lacrimal obstruction, due to its high success rate, besides being safe. The introduction of nasal endoscopy and endoscopic sinus surgery in the. This narrated video focuses on the challenges of and surgical technique for paediatric endoscopic dcr surgery. Dcr is also used for congenital nldo when probing and irrigation, silicone intubation, or. Endoscopic dacryocystorhinostomy bjorl brazilian journal of. It can also be used to carry out other tasks including imaging and minor. I have to have a dacrocystorhinostomy after a rhinoplasty. Dacryocystorhinostomy dcr surgery is a procedure that aims to eliminate fluid and mucus retention within the lacrimal sac, and to increase tear drainage for relief of epiphora water running down the face. We report our 14year single surgeon experience performing endoscopic dcrs from the very young to the elderly with mixed aetiology of epiphora and split in three age groups. Patients often undergo primary open dcr by their ophthalmologist.
Endoscopic dacryocystorhinostomy dcr surgical technique vula. Describe the basic steps of endoscopic dacryocystorhinostomy. Endoscopic dacryocystorhinostomy dcr and stents what is an endoscopic dcr. Understanding endonasal anatomy, wide endoscopic marsupialisation of the lacrimal sac, and meticulous care of the nasal mucosa are important to achieve. Since 1904 5, the surgical management accepted for this disease was the external approach, although caldwell 6 was the first to propose, in 1893, the endonasal approach, unfortunately limited by the technology, at that time. Thirty patient selected for endoscopic dcr were divided into two groups, one of which underwent conventional endoscopic dcr and the other group were treated with a newer technique using cautery. Rates for success for endoscopic dacryocystorhinostomy dcr ranges from 70% 4 to 95%5,6,7. They underwent endonasal endoscopic dcr for primary acquired nasolacrimal duct obstruction. The key to the improved success rates achieved with endoscopic dcr is to attempt to replicate the external procedure as closely as possible. There is limited evidence in literature determining age effect on outcomes of endoscopic dacryocystorhinostomy edcr in adult patients with primary acquired nasolacrimal duct. A dacryocystorhinostomy dcr is an operation to establish free drainage of tears into the nose. Surgical instruments or a laser are used to create an opening between the nose and the lacrimal sac through the mucosa and intervening bone. Dacryocystorhinostomy dcr is a surgical approach for the treatment of nasolacrimal duct obstruction, and endoscopic dcr edcr has become more and more popular in recent years. Powered endoscopic dacryocystorhinostomy with mucosal flaps.
If nldo is left untreated, the symptoms persist and may be distressing for the patient. To evaluate the role of topical mitomycin c in endoscopic dacryocystorhinostomy dcr, for the prevention of stomal stenosis. The diagnosis is clinical, so a thorough clinical history and physical. Closure of the rhinostomy opening was considered a major factor for surgical failure. Dcr is also used for congenital nldo when probing and irrigation, silicone intubation, or balloon catheter dilatation has failed. Prospective study includes 30 patients were operated in the department of ent, misrata medical center, from april 2017 to march 2018. The operation is very similar to external dcr, except there is no cut through the skin and no scar afterwards. Revision external dacryocystorhinostomy results after a. To compare the result and advantages of both endonasal endoscopic and external dcr.
Endonasal endoscopic dacryocystorhinostomy in children. Both kerrison punch and drill are widely used in endoscopic dcr with nonconclusive knowledge about differences. Overview endoscopic dacryocystorhinostomy guidance nice. They both have equal success assuming done by experienced surgeons. However, success is dependent on a thorough understanding of the endonasal anatomy, wide marsupialization of the lacrimal sac, and meticulous care of the mucosa. 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. Dacryocystorhinostomy dcr, one of the major methods to treat dacryocystitis, is a procedure used to create a lacrimal drainage pathway into the nasal cavity. Revision endoscopic dacryocystorhinostomy sciencedirect. The endoscope is introduced into the left nares where the middle turbinate and middle meatus are noted. Apr 22, 2019 endoscopic dacryocystorhinostomy dcr is a recognized procedure performed to treat epiphora caused by anatomical or functional obstruction of the nasolacrimal apparatus. Seventy patients were referred for endoscopic dcr to the senior author between 1997 and 2000.
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