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1.
Braz. j. otorhinolaryngol. (Impr.) ; 88(supl.1): 57-62, 2022. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1420815

ABSTRACT

Abstract Introduction Endonasal and external dacryocystorhinostomy procedures have both been used for the treatment of post-saccular obstruction of the lacrimal system. Functional success of these surgeries depends on several factors. Objective To evaluate the status of the rhinostomy ostium with endonasal and external approaches in dacryocystorhinostomy operations and to determine the effect of ostium size on postoperative functional success. Methods The charts of the patients operated in our hospital between May 2017 and January 2019 were analyzed retrospectively (ethical approval number: 2018-12.04). The patients that were operated in the ophthalmology and otolaryngology departments were included in the study. Endoscopic rhinostomy ostium measurements, punctum lavage findings and complications were recorded at 8 weeks postoperative at the earliest. Results When the 64 patient charts were reviewed (76 operations), the mean ostium width was 1.85 ± 1.11 mm in the endonasal approach group and 3.60 ± 2.24 mm in the external approach group. The mean ostium areas in endonasal and external group were 14.61 ± 16.66 mm2 and 56.05 ± 60.41 mm2, respectively. The ostium was anatomically patent and punctum lavages were negative in 11 patients (6 patients in the endonasal approach group and 5 patients in the external approach group) and these cases were considered as functional failures. The rhinostomy ostium was significantly wider in the external approach group, but this was considered ineffective on functional outcomes. Conclusion Lacrimal duct stenosis can be successfully treated with endonasal and external methods. Tear drainage may be insufficient even in the presence of a patent ostium. Therefore, functional success should also be considered when evaluating the overall success of dacryocystorhinostomy. An anatomically patent ostium is definitely required, while it is believed that ostium size does not affect functional surgical success.


Resumo Introdução Dacriocistorrinostomia endonasal e externa têm sido usados para o tratamento de obstrução pós‐sacular do sistema lacrimal. O sucesso funcional dessas cirurgias depende de vários fatores. Objetivo Avaliar o status do óstio da rinostomia nas abordagens endonasal e externa em dacriocistorrinostomias e a importância do tamanho do óstio no sucesso funcional pós‐operatório. Método Os prontuários de pacientes operados em nosso hospital entre maio de 2017 e janeiro de 2019 foram analisados retrospectivamente (número de aprovação ética: 2018-12,04). Foram incluídos no estudo os pacientes operados nos setores de oftalmologia e otorrinolaringologia. Medidas do óstio da rinostomia endoscópica, achados à irrigação do ponto lacrimal e complicações foram registrados a partir da 8ª semana de pós‐operatório. Resultados Foram avaliados prontuários de 64 pacientes (76 operações); a largura média do óstio era de 1,85 ± 1,11 mm no grupo endonasal e de 3,60 ± 2,24 mm no grupo externa. As áreas médias do óstio no grupo endonasal e externa foram 14,61 ± 16,66 mm2 e 56,05 ± 60,41 mm2, respectivamente. O óstio estava anatomicamente pérvio e as irrigações do ponto lacrimal foram negativas em 11 pacientes (6 pacientes no grupo endonasal e 5 pacientes no grupo externa) e esses casos foram considerados como falhas funcionais. O óstio da rinostomia foi significativamente maior no grupo externo, mas sem relação com a eficácia nos resultados funcionais. Conclusão A estenose do ducto lacrimal pode ser tratada com sucesso com métodos endonasais e externos. A drenagem lacrimal pode ser insuficiente mesmo na presença de óstio pérvio. Portanto, o sucesso funcional também deve ser considerado ao avaliar o sucesso do procedimento. Embora um óstio anatomicamente patente seja necessário, o tamanho do óstio não afeta o sucesso cirúrgico funcional.

2.
Rev. bras. oftalmol ; 81: e0035, 2022. tab
Article in English | LILACS | ID: biblio-1376791

ABSTRACT

ABSTRACT Objective: To evaluate the efficacy of mitomycin C in anatomical and functional success after modified transcanalicular diode laser dacryocystorhinostomy. Methods: A prospective, double-blinded, randomized placebo-controlled study compared the effect of topical mitomycin C on modified transcanalicular diode laser dacryocystorhinostomy. Group 1 had modified transcanalicular diode laser dacryocystorhinostomy with topical saline, while Group 2 had modified transcanalicular diode laser dacryocystorhinostomy with topical mitomycin C. Success was defined as anatomical patency and relief of symptoms at the end of 6 months. Results: Six months after surgery, Group 1 (30 patients) showed anatomical and functional success rates of 86.7% and 83.3%, respectively. Group 2 (32 patients) showed anatomical and functional success rates of 87.5% and 84.3%, respectively. There was no statistically significant difference between the groups 1 and 2 (p = 1.000). Conclusion: The use of mitomycin C did not improve the anatomical and functional success rates of modified transcanalicular diode laser dacryocystorhinostomy compared to placebo.


RESUMO Objetivo: Avaliar a eficácia da mitomicina C no sucesso anatômico e funcional após dacriocistorrinostomia transcanalicular com laser de diodo. Métodos: Estudo prospectivo, duplo-cego, randomizado e controlado por placebo. Comparou o efeito da mitomicina C tópica na dacriocistorrinostomia transcanalicular com laser de diodo. No Grupo 1, foi utilizada apenas solução salina tópica, enquanto no Grupo 2 foi utilizada mitomicina C tópica. O sucesso foi definido como permeabilidade da via lacrimal e alívio dos sintomas ao final de 6 meses. Resultados: Seis meses após a cirurgia, o Grupo 1 (30 pacientes) apresentou taxas de sucesso anatômico e funcional de 86,7% e 83,3%, respectivamente. O Grupo 2 (32 pacientes) apresentou taxas de sucesso anatômico e funcional de 87,5% e 84,3%, respectivamente. Não houve diferença estatística significante entre os Grupos 1 e 2 (p=1,000). Conclusão: O uso de mitomicina C não melhora as taxas de sucesso anatômico e funcional do dacriocistorrinostomia transcanalicular com laser de diodo em comparação ao placebo.


Subject(s)
Humans , Male , Female , Middle Aged , Dacryocystorhinostomy/methods , Mitomycin/administration & dosage , Mitomycin/therapeutic use , Mitomycin/pharmacology , Lasers, Semiconductor/therapeutic use , Nasolacrimal Duct/drug effects , Placebos , Random Allocation , Double-Blind Method , Prospective Studies , Follow-Up Studies , Treatment Outcome , Chemotherapy, Adjuvant , Dacryocystitis/surgery , Laser Therapy/methods , Lacrimal Duct Obstruction/therapy , Nasolacrimal Duct/surgery
3.
Medicentro (Villa Clara) ; 24(3): 564-577, jul.-set. 2020. tab
Article in Spanish | LILACS | ID: biblio-1125016

ABSTRACT

RESUMEN Introducción: la dacriocistorrinostomía externa es la técnica más empleada por la mayoría de los cirujanos oculoplásticos para tratar a los pacientes con obstrucción del canal nasolagrimal. Es posible que los galenos cometan algunos errores en este tipo de cirugía, a pesar de los grandes avances en las tecnologías ópticas, las técnicas quirúrgicas y el uso de modernos materiales de intubación. La principal causa de los errores es el cierre de la osteotomía por tejido cicatrizal o de granulación, con la formación de sinequias en la cavidad nasal. La mitomicina C es el antibiótico alquilante más estudiado en la prevención del exceso de cicatrización en el área de la osteotomía; sin embargo, existen acuerdos y desacuerdos entre estudiosos del tema sobre la eficacia, dosis y tiempo de exposición de este medicamento. El papel de cada una de estas variables en el resultado final de la cirugía es controversial. Objetivo: brindar evidencias sobre el papel de la aplicación transoperatoria de la mitomicina C en la dacriocistorrinostomía externa. Métodos: se realizó una revisión de la bibliografía actualizada disponible en idioma español e inglés. Se consultaron los textos completos y resúmenes en las bases de datos: PubMed, Ebsco, Google Académico y Scielo. También se revisaron novedosos artículos en prestigiosas revistas especializadas. Conclusiones: la mayoría de los autores coinciden en que este medicamento contribuye a elevar la tasa de éxito de la dacriocistorrinostomía externa; aunque su aplicación es segura, todavía se estudian algunas variables que mejorarían su eficacia.


ABSTRACT Introduction: external dacryocystorhinostomy is the most used technique by oculoplastic surgeons to treat patient with nasolacrimal duct obstruction. Physicians may make some mistakes in this type of surgery despite great advances in optical technologies, surgical techniques and the use of modern materials for intubation, The main cause of errors is the closure of the osteotomy due to scar tissue or granulation with synechia formation in the nasal cavity. Mitomycin-C is the most studied alkylating antibiotic in the prevention of excessive scarring in the osteotomy area; however, there are some agreements and disagreements among scholars on the efficacy, dosage and time of exposure of this drug. The role of each of these variables in the final outcome of the surgery is controversial. Objective: to provide some evidences about the transoperative application of Mitomycin-C in external dacryocystorhinostomy. Methods: a review of the updated bibliography available in Spanish and English languages was carried out. Complete texts and abstracts were consulted in the databases: PubMed, Ebsco, Google Scholar and Scielo. Novel articles were also reviewed in prestigious specialized journals. Conclusions: must authors agree that this drug appears to improve the success rate of external dacryocystorhinostomy. Although its application is safe, some variables are still being studied that would improve its efficacy.


Subject(s)
General Surgery , Dacryocystorhinostomy , Mitomycin , Lacrimal Apparatus , Lacrimal Duct Obstruction
4.
Acta otorrinolaringol. cir. cabeza cuello ; 45(4): 267-270, 2017. ilus
Article in Spanish | LILACS, COLNAL | ID: biblio-970518

ABSTRACT

Desde hace muchos años la vía lagrimal la han compartido dos disciplinas: la otorrinolaringología y la oftalmología. Con el paso del tiempo se han desarrollado diferentes técnicas encaminadas al manejo de la patología de la vía nasolagrimal desde la tradicional vía externa hasta los procedimientos asistidos con Láser. La DCR (dacriocistorrinostomia) endoscópica es al día de hoy el procedimiento ideal para el manejo de la insuficiencia y la estenosis de la vía lagrimal, derivado de traumas, dacriocistitis o disfunción de la vía nasolagrimal. Presentamos el reporte de nuestra experiencia en el manejo de estos trastornos en conjunto con el servicio de oftalmología en el Hospital de Ecopetrol de Barrancabermeja, dando especial relevancia a la técnica quirúrgica y a los resultados posoperatorios evitando la morbilidad de la dacriocistorrinostomia externa.


During long time, the lacrimal pathway has been studied and treated by two specialties. Otolaryngology and ophthalmology. As time has gone by, different techniques for treating the lacrimal pathway have been developed, such as the traditional external approach and the laser assisted procedures. Nowadays, endoscopic DCR (dacryocystorhinostomy) is the ideal procedure for treating the lacrimal pathway insufficiency and stenosis secondary to trauma, dacryocystitis or dysfunction of the nasolacrimal pathway. We report our experience in the management of these disorders with the Ecopetrol Hospital in Barrancabermeja's Ophthalmology service, giving special relevance to the surgical technique and the postoperative results avoiding the morbidity of the external dacryocystorhinostomy.


Subject(s)
Humans , Dacryocystorhinostomy , Lacrimal Apparatus , Lacrimal Apparatus Diseases
5.
Med. U.P.B ; 35(2): 135-138, jul.-dic. 2016.
Article in Spanish | LILACS, COLNAL | ID: biblio-837105

ABSTRACT

Los tumores de características malignas en áreas sinonasales ocupan el 3% - 5% de todos los tumores malignos, de estos, los linfomas no Hodgkin de células B son los más comúnmente encontrados. Se ha descrito el compromiso de la cavidad nasal entre el 1.5% y 15%, se describe mayor presentación en pacientes entre las séptima y octava décadas de la vida, así como una tendencia de afectación más en mujeres que en hombres y predisposición en pacientes de raza asiática. La histología mayormente hallada es de carácter no epitelial primario. Muchos de los pacientes en series revisadas han tenido diagnóstico subyacente de enfermedad linfoide en otros sitios previo a la presentación de síntomas nasales como obstrucción nasal, epistaxis, edema, cefalea y visión borrosa. Se presenta un caso de paciente de sexo masculino con diagnóstico de leucemia linfoide crónica, residente en la ciudad de Buenos Aires, en quien durante una dacriocistorrinostomía se halla un linfoma en fosa nasal sin previa presentación de síntomas nasales, masa palpable o síntomas sistémicos.


Malignant tumors in sinonasal areas constitute 3% ­ 5% of all malignant tumors, of which non­Hodgkin lymphomas developing from B cells are those most commonly found. Nasal cavity involvement is described between 1.5% and 15% and is usually found in patients who are in their seventies or eighties. It is more commonly found in women than in men and there is predisposition in Asians. Its histology has been found as non-primary epithelial tumors. Many patients in case series had been diagnosed with primary tumor in other places prior to the presentation of nasal symptoms such as nasal obstruction, epistaxis, edema, headache, and blurred vision. This article describes the case report of a male patient diagnosed with chronic lymphoid leukemia residing in Buenos Aires. While the patient was undergoing a dacryocystorhinostomy, a lymphoid tissue was found in the right nostril without previous presentation of nasal symptoms, palpable mass, or systemic symptoms.


Os tumores de características malignas em áreas sinonasais ocupam 3% - 5% de todos os tumores malignos, destes, os linfomas não Hodgkin de células B são os mais comumente encontrados. Se há descrito o compromisso da cavidade nasal entre 1.5% e 15%, se descreve maior apresentação em pacientes entre as sétima e oitava décadas da vida, assim como uma tendência de afetação mais em mulheres do que em homens e pré-disposição em pacientes de raça asiática. A histologia maiormente encontrada é de carácter não epitelial primário. Muitos dos pacientes em séries revisadas têm tido diagnóstico subjacente de doenças linfoide em outros lugares prévio à apresentação de sintomas nasais como obstrução nasal, epistaxe, edema, cefaleia e visão distorcida. Se apresenta um caso de paciente de sexo masculino com diagnóstico de leucemia linfoide crónica, residente na cidade de Buenos Aires, em quem durante uma dacriocistorrinostomia se encontra um linfoma na fossa nasal sem prévia apresentação de sintomas nasais, massa palpável ou sintomas sistémicos.


Subject(s)
Lymphoma , Otolaryngology , Dacryocystorhinostomy , Histology , Lymphoid Tissue , Neoplasms
6.
Rev. cuba. oftalmol ; 29(2): 251-259, abr.-jun. 2016. tab
Article in Spanish | LILACS | ID: lil-791541

ABSTRACT

Objetivo: describir los resultados de la cirugía dacriocistorrinostomía externa en un año. Métodos: se realizó un estudio observacional, descriptivo longitudinal prospectivo en 25 pacientes, 28 ojos. Se consideraron las variables sexo, color de piel, edad, lado afectado, etiología, complicaciones y resultados de la cirugía. Resultados: hubo 7 pacientes masculinos y 18 femeninos; de ellos, 16 blancos y 9 no blancos con una diferencia estadísticamente significativa (p= 0,043). La edad promedio fue de 69 ± 11 años. En 13 pacientes (52,0 por ciento) se afectó el lado izquierdo y en el 68,0 por ciento la etiología fue involutiva con significación estadística (p= 0,0003). El sangramiento transoperatorio se presentó como complicación en el 24,0 por ciento de los pacientes. El 92,0 por ciento refirió mejoría de la sintomatología después de operados. Según el criterio del cirujano, la mejoría objetiva se obtuvo en el 88,0 por ciento de los casos. La dacriocistorrinostomía externa fue más frecuente en mujeres blancas encontradas entre su sexta y séptima década de vida. El lado izquierdo fue el más afectado con predominio de la etiología involutiva. Las complicaciones fueron escasas; dentro de ellas predominó el sangramiento transoperatorio. Conclusiones: la mayoría de los pacientes sintieron mejoría después de la cirugía; el criterio del cirujano estuvo a favor de los resultados positivos en la cirugía dacriocistorrinostomía externa(AU)


Objective: to describe the results of external dacryocystorhinostomy surgery in one year. Methods: a prospective, longitudinal descriptive and observational study was conducted in 28 patients from 25 patients. The study variables were gender, race, age, affected side, etiology, complications and surgery outcomes. Results: there were 7 male and 18 female patients, 16 Caucasians and 9 non-Caucasians with statistically significant difference (p= 0,043). The mean age was 69 ± 11 years. The obstruction involved the left side in 13 patients (52 percent) and involution was the main etiology in 68 percent with statistical significance (p= 0,0003). Perioperative bleeding was the main complication (24 percent). In the group, 92 percent said the symptoms had reduced after surgery, and according to the surgeon, objective improvement was attained in 88 percent of cases. Conclusion: external dacryocystorhinostomy was more frequent in Caucasian women aged 60 to 70 years. The left side was the most affected, with prevailing involution etiology. There were minimum complications, being perioperative bleeding predominant. Most of the patients felt better after surgery and the surgeon´s criteria were in favor of the positive results of this surgery(AU)


Subject(s)
Humans , Male , Female , Aged , Dacryocystitis/surgery , Dacryocystitis/therapy , Dacryocystorhinostomy/statistics & numerical data , Lacrimal Duct Obstruction/etiology , Epidemiology, Descriptive , Lacrimal Duct Obstruction/pathology , Longitudinal Studies , Observational Study , Prospective Studies , Data Interpretation, Statistical
7.
Rev. otorrinolaringol. cir. cabeza cuello ; 75(3): 220-226, dic. 2015. ilus, tab
Article in Spanish | LILACS | ID: lil-771692

ABSTRACT

Introducción: La dacriocistorrinostomía abierta es el gold estándar para el tratamiento de la obstrucción nasolacrimal, patología manifestada como epífora crónica, dacriocistitis y conjuntivitis recurrente. Desde el desarrollo del abordaje endonasal, se ha considerado como una alternativa terapéutica eficaz con notorias ventajas respecto a la técnica abierta y que además ofrece la posibilidad de corregir otras alteraciones de la nariz y cavidades paranasales en el mismo tiempo quirúrgico. Objetivo: Evaluar los resultados de la técnica quirúrgica endoscópica según la realidad del Hospital Clínico de la Universidad de Chile, durante los años 2010-2014. Determinar la etiología de la obstrucción en los pacientes intervenidos. Material y método: Se realizó un estudio de cohorte retrospectivo con revisión de fichas clínicas de pacientes con diagnóstico de obstrucción de la vía lacrimal sacular y postsacular sometidos a dacriocistorrinostomía endoscópica. Se incluyeron 27pacientes entre los cuales se realizaron 33 cirugías, ya que 22,2% de ellos (6/27) fueron sometidos a intervención bilateral. Resultados: El éxito quirúrgico objetivo y subjetivo se presentó en 75,8% (25/33) y 65,4% (17/26) respectivamente. El 7,4% (2/27) presentaron complicaciones intraoperatorias (falsa vía y extrusión de grasa orbitaria) y 18,5% (5/27) complicaciones posoperatorias (sinequias y fibrosis). Dentro de las causas destacan: idiopática 66,7% (18/27), postraumática 14,8% (4/27), secundaria a utilización de radioyodo 11,1% (3/27), granulomatosis de Wegener3,7% (1/27)y congénita 3,7% (1/27). La sonda instalada se mantuvo por un promedio de 3,5 meses, y el seguimiento se realizó por un periodo de 7,4 meses. Conclusión: La dacriocistorrinostomía endoscópica resulta ser una excelente herramienta quirúrgica para el manejo de pacientes con diagnóstico de obstrucción nasolacrimal, siendo un procedimiento exitoso, seguro, con baja tasa de complicaciones y una muy buena evolución posoperatoria, recomendado para todos aquellos casos con mala respuesta a las terapias médicas.


Introduction: Open dacryocystorhinostomy is the gold standard for the treatment of nasolacrimal obstruction, pathology manifested as chronic epiphora, recurrent dacryocystitis and conjunctivitis. Since the development of endonasal approach, it has been considered as an alternative therapy with notable advantages over the open technique and offers the possibility to correct other abnormalities of the nose and paranasal sinuses in the same surgical time. Aim: To evaluate the results of endoscopic surgical technique according to the reality of the Clinical Hospital of the University of Chile, during the years 2010-2014. Determine the etiology of the obstruction in patients undergoing surgery. Material and method: A retrospective cohort study was performed with review of clinic files of patients diagnosed with lacrimal duct obstruction submitted to an endoscopic dacryocystorhinostomy. 27 patients were included and 33 surgeries were performed, as 22.2% of them (6/27) underwent bilateral intervention. Results: Objective and subjective surgical success occurred in 75,8% (25/33) and 65,4% (17/26) respectively. 7,4% (2/27) had intraoperative complications (false passage and orbital fat extrusion) and 18,5% (5/27) postoperative complications (fibrosis and synechiae). Among the causes are: idiopathic 66,7% (18/27), postraumatic 14.8% (4/27), history of radioiodine use 11.1% (3/27), Wegener's granulomatosis 3.7% (1/27) and congenital 3.7% (1/27). Probe Installed was kept for an average of 3,5 months, and the follow-up was performed for 7,4 months. Conclusions: Endoscopic dacryocystorhinostomy is an excellent surgical tool for the management of patients with nasolacrimal obstruction. It's a successful procedure, with low rate of complications and good postoperative outcome, recommended for those cases with poor response to medical therapies.


Subject(s)
Humans , Male , Female , Adult , Dacryocystorhinostomy/statistics & numerical data , Endoscopy/methods , Lacrimal Duct Obstruction , Nasolacrimal Duct/surgery , Postoperative Complications , Chile , Retrospective Studies , Treatment Outcome , Intraoperative Complications , Lacrimal Duct Obstruction/etiology
8.
Rev. bras. oftalmol ; 73(5): 311-313, Sep-Oct/2014. graf
Article in English | LILACS | ID: lil-741896

ABSTRACT

A dacriocistocele representa um saco lacrimal dilatado e é frequentemente considerada como tendo uma etiologia congênita. No entanto, dacriocistocele é uma doença rara em adultos. A característica clínica se caracteriza por um abaulamento indolor na região medial da órbita, inferior ao ligamento cantal medial. O teste de excreção lacrimal, endoscopia, tomografia computadorizada e ressonância magnética são utilizados para fazer o diagnóstico de dacriocistocele. Semelhante a pacientes pediátricos, marsupialização endoscópica do cisto nasal e a colocação de stent parece ser a terapêutica adequada. Em alguns casos o tratamento consiste na dacriocistorrinostomia externa.


The dacryocystocele represents a dilated lacrimal sac and is often considered as having a congenital etiology. However, dacryocystocele is a rare disease in adults. The clinical feature is characterized by a painless bulge in the medial region of the orbit, below the medial canthal ligament. The lacrimal excretion test, endoscopy, computerized tomography and magnetic resonance image are used to make the diagnosis of dacryocystocele. Similar to pediatric patients, endoscopic marsupialization of the cyst with nasal stenting seems to be the appropriate therapy. In some cases the treatment consists of external dacryocystorhinostomy.


Subject(s)
Humans , Female , Adult , Dacryocystitis/drug therapy , Lacrimal Duct Obstruction/diagnosis , Lacrimal Duct Obstruction/drug therapy , Dacryocystorhinostomy , Catheterization , Dacryocystitis/surgery , Endoscopy , Anti-Bacterial Agents/therapeutic use
9.
Braz. j. otorhinolaryngol. (Impr.) ; 78(5): 7-11, set.-out. 2012. tab
Article in Portuguese | LILACS | ID: lil-654280

ABSTRACT

OBJETIVO: Comparar uma técnica composta de dacriocistorrinotomia (DCR) endoscópica à técnica convencional. MÉTODO: Foi realizado um estudo prospectivo no Departamento de Otorrinolaringologia da Faculdade de Medicina Maulana Azad. Trinta pacientes selecionados para DCR endoscópica foram divididos em dois grupos, um submetido à DCR endoscópica convencional e outro tratado com uma técnica mais nova com o uso de cautere, instrumentação fria e laser em diferentes etapas da DCR endoscópica. Os pacientes foram seguidos por nove meses. RESULTADOS/CONCLUSÃO: Com o uso do cautere, instrumentação fria e laser em diferentes etapas da DCR endoscópica, fomos capazes de obter taxa de sucesso de cerca de 94% com a técnica composta em comparação a 83,3% da DCR endoscópica convencional.


AIM: To compare a composite technique of Endoscopic Dacrocystorhinostomy with the conventional technique. METHODS: A randomised prospective study was carried in the department of Otolaryngology Maulana Azad Medical College. 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, cold instrumentation and laser at different steps of Endoscopic DCR. The patients were followed up for Nine months. RESULTS/CONCLUSION: By using cautery, cold instrumentation and laser at different steps of Endoscopic DCR we were able to achieve a success rate of around 94% with this composite technique as compared to 83.3% in conventional Endoscopic DCR surgery.


Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Dacryocystorhinostomy/methods , Endoscopy/methods , Lacrimal Duct Obstruction/surgery , Combined Modality Therapy , Cautery/methods , Laser Therapy/methods , Prospective Studies , Treatment Outcome
10.
Rev. bras. oftalmol ; 70(6): 404-407, nov.-dez. 2011. graf
Article in Portuguese | LILACS | ID: lil-612915

ABSTRACT

OBJETIVO: O objetivo do projeto de pesquisa é determinar a incidência das complicações intra e pós-operatória da dacriocistorrinostomia externa efetuadas pela autora, no Hospital São Paulo, no período de 10 de abril de 2009 a 15 de janeiro de 2010. MÉTODOS: Estudo retrospectivo observacional dos prontuários dos pacientes submetidos à dacriocistorrinostomia externa no Hospital São Paulo, no período de 10 de abril de 2009 a 15 de janeiro de 2010.Os pacientes foram submetidos à avaliação oftalmológica: inspeção ocular, biomicroscopia,Teste de Milder, Teste de Jones I e II e exame de dacriocistografia. É mister salientar que os pacientes incluídos neste estudo foram examinados pela autora deste trabalho. RESULTADOS: Neste trabalho, verificou-se que das 15 dacriocistorrinostomias externas realizadas as complicações intra-operatórias encontradas foram: sangramento(46,66 por cento), perda do retalho da mucosa nasal (26,66 por cento), utilização do martelo na osteotomia(6,66 por cento). Em relação as complicações pós-operatórias citamos: fístula cutânea (6,66 por cento), cicatriz hipertrófica (6,66 por cento). Observou-se 1 caso de falência, correspondendo a 6,66 por cento das cirurgias realizadas. O tempo médio de acompanhamento pós-operatório dos pacientes foi de 4 meses. CONCLUSÃO: Neste trabalho, o índice de sucesso obtido por esta técnica cirúrgica foi grande, podendo afirmar que a dacriocistorrinostomia externa oferece ótimos resultados.


PURPOSE: The research project goal is to determine the incidence of complications during the external dacryocystorhinostomy and post surgery done by the author, in São Paulo Hospital, from april 10th , 2009 to january 15th, 2010. METHODS: This is a retrospective study of the records of the patients submitted to external dacryocystorhinostomy in São Paulo Hospital, from april 10th 2009 to january 15th, 2010.The patient were submitted to the ophtahalmologic evaluation: Ocular inspection, biomicroscopiy, Milder Test, Test of Jones I and II and dacryocystograph exam. It is important point out, that the included patients in this study, the patients were examined by the author of this work. RESULTS: This study was verified that out of 15 external dacryocystorhinostomy done, the complications were: bleeding (46,66 percent), oddment loss of the nasal mucosa (26,66 percent,utilização) of the hammer in the osteotomy (6,66 percent).The pos-operatory complications: cutaneous fistula (6,66 percent), hypertrophic (6,66 percent). Among the 15 surgeries there was only 1 failure corresponding to the 6,66 percent. The average time of surgery follow-up was of 4 months. CONCLUSION: The external dacryocystorhinostomy offers great results,according this study.


Subject(s)
Humans , Postoperative Complications , Dacryocystorhinostomy/adverse effects , Intraoperative Complications , Nasal Cavity/surgery , Nasolacrimal Duct/surgery , Dacryocystorhinostomy/methods , Medical Records , Retrospective Studies , Cicatrix, Hypertrophic/etiology , Fistula/etiology , Hemorrhage/etiology , Lacrimal Duct Obstruction
11.
Acta otorrinolaringol. cir. cabeza cuello ; 39(4): 181-190, dic. 2011. ilus
Article in Spanish | LILACS | ID: lil-682765

ABSTRACT

Objetivo: Valorar el impacto en calidad de vida de la dacriocistorrinostomía endoscópica convencional con colocación de stent de silicona, utilizando un cuestionario validado sobre calidad de vida, Glasgow Benefit Inventory (GBI) versión en español; teniendo en cuenta la ausencia de estudios que evalúen el verdadero impacto de esta cirugía en nuestro medio. Ámbito: Hospital Universitario de 4o nivel. Materiales y métodos: 34 pacientes llevados a dacriocistorrinostomía endoscópica con colocación de stent, para un total de 43 procedimientos (algunos pacientes requirieron procedimiento bilateral), se les realizó cuestionario telefónico (GBI) y test de Munk posoperatorio para evaluar el grado de epífora, todos los pacientes tenían un seguimiento mínimo de 6 meses posoperatorios. Resultados: Un total de 22 pacientes completaron el cuestionario y el test, un total de 30 procedimientos quirúrgicos fueron evaluados. Un GBI promedio total fue de + 39,9 para los pacientes con resultados excelentes y buenos y de -9.7 para los pacientes con resultados malos. Conclusión: La dacriocistorrinostomía endoscópica con colocación de stent de silicona tiene un impacto positivo sobre la calidad de vida de pacientes adecuadamente seleccionados...


Objective: To assess the impact on quality of life of conventional endoscopic dacryocystorhinostomy with silicone stent placement, using a validated questionnaire on quality of life, Glasgow Benefit Inventory (GBI) Spanish version, taking into account the lack of studies evaluating the true impact of this surgery in our country. Scope: Tertiary medical center. Materials and methods: 34 patients who underwent endoscopic dacryocystorhinostomy with stent placement for a total of 43 procedures (some patients required bilateral procedure). A telephone questionnaire (GBI) and postoperative Munk’s test were performed to assess the degree of epiphora, all patients had a 6 months follow up postoperatively. Results: A total of 22 patients completed the questionnaire and the test, a total of 30 surgical procedures were evaluated. A GBI total average was + 39.9 for patients with excellent or good results and -9.7 for patients with poor results. Conclusion: Endoscopic dacryocystorhinostomy with silicone stent placement has a positive impact on quality of life for appropriately selected patients...


Subject(s)
Humans , Quality of Life , Dacryocystorhinostomy , Dacryocystorhinostomy/classification , Dacryocystorhinostomy/rehabilitation
12.
Arq. bras. oftalmol ; 74(4): 283-285, jul.-ago. 2011. ilus
Article in English | LILACS | ID: lil-604179

ABSTRACT

PURPOSE: External dacryocystorhinostomy is routinely performed through a cutaneous vertical incision placed on the lateral aspect of the nose. The lower eyelid crease approach has been seldom reported. The purpose of this study is to report the cosmetic and functional results of the lid crease approach for external dacryocystorhinostomy in a series of patients. METHODS: Prospective, interventional case series. Twenty-five consecutive patients (17 women) ranging in age from 3 to 85 years (mean ± SD= 44.84 ± 23.67) were included in the study. All patients but one underwent unilateral external dacryocystorhinostomy with a 10 to 15 mm horizontal incision placed on a subciliary relaxed eyelid tension line. The inner canthus was photographed with a Nikon D70S digital camera with a macrolens and resolution of 3008 x 2000 pixels at 1, 3 and 6 months after surgery. The resulting scar was judged from the photographs by 3 observers (ophthalmologist, plastic and head and neck surgeons) according to a four level scale (1= unapparent, 2= minimally visible, 3= moderately visible, 4= very visible). RESULTS: The surgery was easily performed in all patients with a 90.48 percent success. Three of the elderly patients (ages 61, 79 and 85 yr) developed mild lacrimal punctum ectropion, which resolved with conservative treatment. One patient had a hypometric blink which spontaneously recovered within one month. The mean score for scar visibility was 2.19 (1st mo), 1.65 (3th mo) and 1.44 (6th mo). CONCLUSIONS: The eyelid crease approach is an excellent option for external dacryocystorhinostomy. It leaves an unapparent scar since the first month after surgery, even in younger patients. The functional results are excellent and comparable to other techniques. Care should be taken in elderly patients with lower eyelid laxity in order to prevent lacrimal punctum ectropion.


OBJETIVOS: A dacriocistorrinostomia externa é classicamente realizada por meio de incisão cutânea nasal. Há poucos relatos sobre a incisão transpalpebral, posicionada no sulco infraciliar da pálpebra inferior. O presente estudo tem por objetivo relatar os aspectos cosméticos e funcionais utilizando a técnica transpalpebral. MÉTODOS: Série de casos, intervencional e prospectivo. Foram incluídos 25 pacientes consecutivos (17 mulheres) com idades variando de 3 a 85 anos (média ± dp= 44,84 ± 23,67), que apresentavam dacriocistite crônica. A dacriocistorrinostomia foi unilateral em 24 casos e bilateral em 1 caso. A incisão transpalpebral foi posicionada no sulco infraciliar medial, com extensão de 10 a 15 mm. Foram realizadas fotografias digitais do canto interno (Nikon D70S, lente macro, resolução de 3008 x 2000 pixels) nos tempos pós-operatórios 1, 3 e 6 meses. A visibilidade da cicatriz foi avaliada por 3 observadores (oftalmologista, cirurgião plástico e cirurgião de cabeça e pescoço) utilizando a seguinte escala: 1= imperceptível, 2= minimamente visível, 3= moderadamente visível, 4= muito visível. RESULTADOS: A DCR foi realizada sem dificuldades e com sucesso funcional em 90,48 por cento dos casos. A pontuação média para visibilidade da cicatriz foi de 2,19 (1º mês), 1,65 (3º mês) e 1,44 (6º mês). Houve 3 casos de ectrópio leve do ponto lacrimal que foram tratados conservadoramente. Um paciente apresentou piscar espontâneo incompleto, com resolução no primeiro mês de pós-operatório. CONCLUSÃO: A incisão transpalpebral é uma excelente via de acesso para realização da dacriocistorrinostomia. A cicatriz é pouco visível desde o primeiro mês após a cirurgia, mesmo em pacientes mais jovens. Os resultados funcionais são semelhantes ao das outras técnicas. Em pacientes mais idosos é necessário avaliação cuidadosa da frouxidão palpebral a fim de evitar a indução de ectrópio lacrimal.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Young Adult , Dacryocystorhinostomy/methods , Eyelids/surgery , Lacrimal Duct Obstruction/surgery , Cicatrix , Follow-Up Studies , Prospective Studies , Treatment Outcome
13.
Braz. j. otorhinolaryngol. (Impr.) ; 76(1): 34-39, jan.-fev. 2010. ilus, tab
Article in English, Portuguese | LILACS | ID: lil-541434

ABSTRACT

A dacriocistorrinostomia é o tratamento de escolha para a obstrução do aparelho lacrimal. No final do século passado, o desenvolvimento da instrumentação endoscópica em cirurgia nasossinusal tornou viável sua realização por via endonasal. Entretanto, variações anatômicas tornam difícil a reprodutibilidade de uma técnica de abordagem endonasal. Objetivo: Estudar a anatomia endoscópica da fossa lacrimal através da transiluminação do canalículo comum. Forma de estudo: Experimental. Material e método: Foram dissecadas 40 vias lacrimais de 20 cadáveres humanos, constando três etapas: 1 - identificação e dilatação do canalículo lacrimal. 2 - introdução do feixe de fibra óptica; 3 - dissecção endoscópica do saco lacrimal, descrevendo sua posição. Resultados: A posição mais frequente do saco lacrimal foi entre a borda livre do corneto médio e sua inserção e imediatamente abaixo desta. A linha maxilar foi visualizada em 95 por cento dos casos. A septoplastia foi necessária em 12,5 por cento, uncifectomia em 35 por cento e turbinectomia média em 7,5 por cento. Conclusão: embora o saco lacrimal tenha mostrado uma localização mais frequente, sua posição variou consideravelmente. A transiluminação do canalículo comum mostrou-se útil, resolvendo o problema da variabilidade anatômica.


Dacryocystorhinostomy is the treatment of choice for the obstruction of the lachrymal apparatus. At the end of last century, the development of the endoscopic instruments for nasosinusal surgery has made it possible to do it through the endoscopic pathway. Nonetheless, anatomical variations make it difficult to have reproducibility endonasaly. AIM: study the endoscopic anatomy of the lachrymal fossa through transillumination of the common canaliculus. Study design: experimental. Materials and methods: we dissected 40 lachrymal pathways from 20 human cadavers, in three stages: 1. identification and dilation of the lachrymal canaliculus. 2 - Optic fiber beam introduction; 3 - endoscopic dissection of the lachrymal sac, describing its position. Results: the most frequent position of the lachrymal sac was between the free border of the middle turbinate and its insertion immediately underneath it. The maxillary line was seen in 95 percent of the cases. Septoplasty was needed in 12.5 percent, unicifectomy in 35 percent and middle turbinectomy in 7.5 percent. Conclusion: Although the lachrymal sac has a more frequent location, its position varied considerably. The transillumination of the common canaliculus proved useful, solving the problem of the anatomical variability.


Subject(s)
Female , Humans , Male , Nasolacrimal Duct/anatomy & histology , Transillumination/methods , Cadaver , Dacryocystorhinostomy , Endoscopy
14.
Salud(i)ciencia (Impresa) ; 16(3): 280-282, ago. 2008. ilus
Article in Spanish | LILACS | ID: biblio-836555

ABSTRACT

La epífora producida por obstrucción del conductor nasolagrimal ha sido tratada tradicionalmente con una dacriocistorrinostomía externa (DCR). La DCR endonasal puede ofrecer asimismo una tasa elevada de permeabilidad prolongada del conducto sin requerir una incisión nasal externa y sin interrupción del ligamento de canto medial y el efecto posterior que esto puede tener sobre el mecanismo de bomba lagrimal. Esta revisión describe la técnica de la DCR endonasal de alta potencia y resume los resultados logrados con esta técnica.


Epiphora caused by obstruction of the nasolacrimal ducthas traditionally been treated with an external dacrocystorhinostomy (DCR). Endonasal DCR can offersimilarly high rate of long term duct patency without requiring an external nasal incision and without the disruption of the medial canthal ligament and subsequent effect that this may have on the lacrimal pump mechanism. This review describes the technique of powered endonasal DCR and summarises the results achieved with this technique.


Subject(s)
Dacryocystorhinostomy , Lacrimal Apparatus Diseases , Nasolacrimal Duct , Ophthalmology
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