Simple bone removal technique in endonasal dcrendoscopic. The study involved a prospective nonrandomised interventional case series with short perioperative follow up. 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. Instructions following endonasal dcr surgery other medications pg2 eye drops, if prescribed, are instilled into the eye 3 times a day. External versus endonasal dacryocystorhinostomy in a. To compare success rates of external dacryocystorhinostomy dcr and endoscopic endonasal dcr for acquired nasolacrimal duct obstruction nldo. Anaesthesia for dacryocystorhinostomy sciencedirect. Using self retaining speculum one can work bimanually. Endoscopic dcr is also technically more difficult to learn, and the learning curve for the endoscopic procedure has been reported in several studies. Outcome of endonasal endoscopic dacryocystorhinostomy in. Despite ease and decreased morbidity of endonasal dcr, external dcr is procedure of choice as it is more successful. Resolution of symptoms of watering in outdoor conditions was reported by 84% of the participants in the external dcr group and 59% of those in the laserassisted endonasal dcr group rr 0.
The study included 88 patients who underwent 102 consecutive endcr 56 cases or exdcr 46 cases procedures performed by a single ophthalmologist. Our experience endonasal dacryocystorhinostomy is considered to be the standard treatment for chronic dacryocystitis, and is simple to perform and is very effective even in patients. Efficacy of endo nasal dcr in primary nasolacrimal duct. Dcr for which the endonasal dcr has been gaining popularity for last few decades. Results could prove useful in understanding the role of the lacrimal pump after dcr and associated differences between the external and the endonasal approaches. Nasal mucoperiosteum was incised and then excised in the diameter of 5 mm to 8 mm to expose lacrimal bone at the anterior end of middle turbinate. This procedure involves the creation of ostium at the lacrimal bone to form a shunt in the nasolacrimal pathway. In comparison to transcutaneous dcr, endonasal dcr has certain benefits. Reported complications of endonasal dcr do not generally appear to be greater in frequency or magnitude than those associated with external dcr. Longterm results of endonasal dacryocystorhinostomy.
The succsess rate is similar and at the same time it avoids the pitfalls of external dcr. Various advantages seen with microrhinoscopic endonasal revision dcr 5. May 24, 2016 this video demonstrates endoscopic dcr performed on a 57yearold female. The files of 165 patients who underwent endonasal dcr at a tertiary referral centre between 1991 and 2001 were retrospectively assessed. To compare success rates of external dacryocystorhinostomy dcr and endoscopic endonasal dcr for acquired nasolacrimal duct. Endoscopic or endonasal dcr is a surgery to correct excessive tearing. Success rates are typicaly reported to be in the range of 85% to 90%. Some of the patients who had only a short follow up time may subsequently fail. For bone removal, kerrisons punch and dcr burr was used. Surprisingly, an endonasal approach to the lacrimal system was first described before that, in 1893, by caldwell. 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. Intraoperative bleeding was an intraoperative complication in endonasal dcr. If you have any further questions, please speak to a doctor or nurse caring for you. Abnormal tearing or epiphora watery eyes takes place due to obstruction in.
One study was from india and compared mechanical endonasal dcr using punch forceps with external dcr. Toti 1 was the first to describe dacryocystorhinostomy dcr, performed externally, to treat nldo. Endoscopic vs external dacryocystorhinostomycomparison from. There were no cases of intraoperative bleeding in any participant in the trial that compared. This study was carried out to evaluate the results of endonasal dcr surgery and to access efficacy of this procedure without stenting. This relatively new development on the traditional technique of external dcr represents an increasingly common skillset in rhinologic practice. The success rates for endonasal dacryocystorhinostomy.
Endonasal endoscopic dacryocystorhinostomy in misrata central hospital, libya. Mri evaluation of lacrimal drainage after external and. The standard surgical procedure for treatment of nasolacrimal duct obstruction nldo is dacryocystorhinostomy dcr which restores normal lacrimal outflow. Endonasal cranial correction advanced biostructural correction. From our population n30, 5 cases needed a revision surgery and 2 cases underwent a second revision dcr. There is excellent illumination and magnification 2. This article tries to provide few tips to make dcr easy and stressfree.
Applications in imageguidance, surgical simulation and patientspecific. The human body is a single synchronized functioning unit. Endoscopic endonasal dcr is an effective treatment modality for congenital nldo that compares. The name for this surgical procedure is dacryocystorhinostomy. Physical forces on the skull invariably come from outsidein. Success rate of endonasal dcr appears similar to external. Endonasal endoscopic dcr and externaldcr in primary. 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. Diverticula of the lacrimal sac may be present which can cause persistentt infection leading to. This potentially leads to cleaner surgical fields and improved surgical efficiency. This is a new technique that involves creation of a large rhinostomy and mucosal flaps. A form of acupuncture in which acupoints inside of the nose are stimulated. Endoscopic endonasal dcr is a specialised procedure, which not all oculoplastic lacrimal surgeons offer. Endoscopic dacryocystorhinostomy oculoplastic eyelid.
Therefore, powered endoscopic dcr with mucosal flaps without stenting has a success rate comparable to that achieved with stents and external dcr. Learning curve is stiff due to requirement of few adjunct procedures. In our study, we under took bone removal with kerrisons 2 mm punch. Bicanalicular silicone stents in endonasal dcr american. Intaoperative and postoperative complications in dcr were. That means that every part of the body functions in a synchronized fashion. A retrospective analysis of more than 1,500 patients, who underwent primary endoscopic dcr, was done and specific small modifications were identified and applied in the next 108 cases showing an improvement in the results. Endonasal versus external dacryocystorhinostomy for. Endoscopic endonasal surgery is a minimally invasive technique used mainly in neurosurgery and otolaryngology. The endonasal dcr was performed with the help of endoscope and tv set. The purpose of this study was to improve the long term surgical outcome in endonasal dcr. Eedcr is a highly rewarding endoscopic procedure for management of dacryocystitis when epiphora does not respond to medications or repeated syringing of nasolacrimal duct. Endoscopic dacryocystorhinostomy, epiphora, lacrimal stents introduction caldwell1 was the first to describe an endonasal approach to treat nasolacrimal duct. To assess the subjective success and quality of life of adult patients post endoscopic endonasal dacryocystorhinostomy eedcr for acquired nasolacrimal duct obstruction.
Lettris is a curious tetrisclone game where all the bricks have the same square shape but different content. Data are reported on a series of 52 endoscopic procedures of dacryocystorhinostomy, performed in the department of otorhinolaryngology of the hospital of varese, between may 1999 and february 2003. Other alternative is endonasal laser dcr, which is not the procedure of first preference, due to its high cost, long operation time and less satisfactory results 8 the inferior results achieved with laser dcr may be due to the size of the ostia created. Watering eye surgery endoscopic endonasal dcr clinica. Pdf to describe the technique of nonendoscopic endonasal dacryocystorhinostomy nendcr, and its indications and results. Endonasal correction works at the same level on which the problem was created.
Mechanical endonasal dacryocystorhinostomy with mucosal flaps. Health outcomes for endonasal dacryocystorhinostomy dcr. Repeat endonasal dcr with or without mitomycin c can be considered. The cochrane researchers are uncertain whether endonasal dcr increases the chance of success compared with external dcr, or whether endonasal dcr reduces the chance of complications such as bleeding or wound infection. The success rates for mechanical endonasal dcr reported by tsirbas and wormald 1 appear to be very good 95% anatomical and 89% functional success, but their follow up period varied from only 2 months to 28 months mean 9. Oct 04, 20 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. Endonasal cranial correction by abc is truly a paradigm shift in the physical medicine field. Pdf external dacryocystorhinostomy under local anesthesia. Endonasal dacryocystorhinostomy dcr with protected drill. The basic indication is same in all cases and either route can be used.
Comparison of nonlaser nonendoscopic endonasal dacryocystorhinostomy with external dacryocystorhinostomy. Despite the advantages, the general impression is that endonasal dcr has a lower success rate than external dcr. External dcr is the traditional surgical approach, however endoscopic dcr can be done. Exdcr was first described by toti in 1904 and is the most widely practiced procedure. Endoscopic intra nasal approach to bypass the obstruction of lacrimal apparatus is a simple and commonly practiced surgery among the ent surgeons. Endonasal endoscopic dacryocystorhinostomy in misrata. Powered endoscopic dacryocystorhinostomy with mucosal. This document describes endonasal dacryocystorhinostomy dcr and. The spiway is the first and only access guide for endoscopic endonasal skull base surgery. 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. We found that 14 46,7% patients had comorbidities, including concomitant sinonasal pathology was present in 12 40%. Endoscopic dacryocystorhinostomy dcr surgical technique vula. Nasal sprays may also be prescribed, and instructions about their use will be provided.
Conventional dacryocystorhinostomy versus endonasal. An instructional video on the surgical technique of an endonasal dacryocystorhinostomy dcr. Several ophthalmologists fear performing dcr because of bleeding and unfamiliarity of structure. Caldwell 1 and toti 2, respectively, described the endonasal and external approaches to dacryocystorhinostomy dcr 1, 2. Mechanical endonasal dacryocystorhinostomy a reproducible technique. Postoperative problems with lacrimal patency including canalicular obstruction occurred to 6. After complete exposure, the lacrimal sac was incised and. The wonders of endonasal therapy my head has been chronically congested on the right side for many years. Various modifications in the form of usage of micro drill, application of mitomycin c and preserving. It can be done with external ex or endonasal en access. 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. Although retrospective, this study is a very useful addition to the literature because it shows that endonasal dcr using the authors techniques has the same chance of success as external dcr.
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. 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. Nonendoscopic mechanical endonasal dacryocystorhinostomy. A neurosurgeon or an otolaryngologist, using an endoscope that is entered through the nose, fixes or removes brain defects or tumors in the anterior skull base.
Endonasal therapy definition of endonasal therapy by. They found a higher rate of success in the stent surgeries. To make squares disappear and save space for other squares you have to assemble english words left, right, up, down from the falling squares. Bilateral endonasal endoscopic dcr was performed in 5 patients, with a total of 35 primary dcrs in our group.
Endoscopic, endonasal, or transnasal dacryocystorhinostomy. Advantages of the internal, or endonasal, approach include lack of a skin incision. An experts view shrikant deshpande, anjaneya agashe, abhinav loomba, neha dhiware department of ophthalmology, mahatma gandhi mission medical college, navi mumbai, maharashtra, india. Fifty patients who underwent ext or end dcr between january 20102012 were involved in the study. Primary endoscopic endonasal dacryocystorhinostomy for. Comparison of modified conventional dcr with endonasal dcr.
This is a prospective clinical study conducted in departments of ent and ophthalmology, l. 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. 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. The success rate of endonasal dcr was 98% in 117 cases 2, issue 2, february, 2015. Jan 29, 2015 endoscopic or endonasal dcr is a surgery to correct excessive tearing.
Endonasal dcr is a successful intervention with demonstrable health benefits to the patient, especially for revision cases. 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. Endonasal versus external dacryocystorhinostomy for nasolacrimal. Pdf on dec 10, 2018, balwant singh gendeh and others.
Pdf comparison of nonlaser nonendoscopic endonasal. Endonasal endoscopic dcr is the best at present treatment of dcr. This included three patients with postoperative hemorrhage two who had endonasal dcr surgery and one having external dcr surgery. Endoscopic endonasal dcr is a valid alternative to external dcr.
It is in fact very similar to the external dcr except there is no cut through the skin and therefore no chance of scar afterwards. It is a simple, less time consuming, safe but skilful, highly satisfying surgery both for the patients as well as the surgeons. Successful external dcr creates a 24mm ostium on average regardless of bony osteotomy size bumsted, arch otolaryngol 1982. This study is undertaken to evaluate the efficacy of endonasal dcr in terms of successful outcome, intraoperative and postoperative complications. Both forms of dcr surgery may be performed under monitored sedation or general anesthesia based on the surgeon and patients preference.
The spiway is designed to help reduce mucosal trauma and keep the scope clean. An assessment of those significant reports about dcr techniques. You may also be prescribed antibiotic tablets or capsules. To describe and assess the efficacy of mechanical endonasal dacryocystorhinostomy mendcr. 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. Endonasal dcr is a safe and effective procedure in children indicated only when the. Endonasal versus external dacryocystorhinostomy for nasolacrimal duct obstruction. Our experience microscope to identify the punctum in these cases. To compare the success and complication rates, duration of surgeries and clinical comfort after endoscopic dacryocystorhinostomy end dcr or external dacryocystorhinostomy ext dcr. The obstruction of the nasolacrimal passage which causes watering is a common problem and results in. This dates back at least as far as my college days, and may have been initially instigated by a really bad cold i had once while living there.
Published success rates for external dcr, endonasal dcr and endocanalicular laser dcr range widely from 50% to 99%. Patient satisfaction following endoscopic endonasal. A prospective study was conducted on 84 patients of nasolacrimal duct obstruction with chronic dacryocystitis. This video demonstrates a simplified bone removal technique in endoscopic endonasal dcr without powered instrumentation. Dacryocystorhinostomy dcr is a surgical procedure performed for the relief of nasolacrimal duct obstruction nldo. Caldwell, west and mosher replaced endonasal dcr in early 1900 5, 6, 7. 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. It is unclear whether or not endonasal dacryocystorhinostomy dcr is a better way of treating tear duct obstruction than external dcr very low. Endonasal endoscopic dacryocystorhinostomy have failed a primary conventional dcr. Dacryocystorhinostomy dcr this leaflet explains about dacryocystorhinostomy dcr including the benefits, risks and any alternatives, together with what you can expect when you come to hospital.
Endonasal dacryocystorhinostomy ota american academy of. I am grateful to kuopio university language centre for inventing the writing clinic and especially to. Failing or failed endonasal dcr can occur from mucosal stenosis at the ostium. Comparison of external and endonasal dacryocystorhinostomy. Listing a study does not mean it has been evaluated by the u. Metson reported a 75% success rate with revision edcr for failed primary external dcr 2 the role of edcr is not to replace the conventional dcr, butto enhance and provide an alternative approach for the treatment of lacrimal obstruction. Jul 12, 2011 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.
Endoscopic dacryocystorhinostomy oculoplastic eyelid orbit. Though success rates are higher with external dcr, endonasal endoscopic laser dcr offers certain advantages over the external approach while. His dacryocystorhinostomy through an endonasal approach evaded popularity because of. There is very big advantage of eedcr, it is close 100% successful procedure, even if there is. Endonasal dacryocystorhinostomy is widely accepted and effective treatment option for nasolacrimal duct obstruction. Nonendoscopic endonasal dacryocystorhinostomy springerlink. The aim of study was to compare and analyze surgical success and patient satisfaction in doing external dacryocystorhinostomy and endonasal endoscopic dacryocystorhinostomy for the management of primary acquired nasolacrimal duct obstruction at tertiary care referral hospital in.
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