Comparison of Drills Used in Endonasal Dacryocystorhinostomy

PURPOSE: To evaluate and compare two types of microdrills that are used in endonasal dacryocystorhinostomy. METHODS: We retrospectively analyzed medical records and video recordings of 51 patients with 65 affected eyes who underwent endonasal dacryocystorhinostomy for treatment of chronic dacryocystitis or primary acquired nasolacrimal duct obstruction at our hospital between 2005 and 2007. All procedures were performed by the same surgeon. The patients were randomly divided into two groups. For patients in group 1 the surgeon used the Diego powered dissector (Gyrus(R)), while patients in group 2 were treated using the Ossepro (Bein Air(R)) microdrill. RESULTS: The operation success rate of group 1 was 96.6% and of group 2 was 94.2%. This difference was not statistically significant (p>0.05). The mean operation time was longer in group 1 (45.6 min) than in group 2 (65.8 min). These values, along with the mean drill usage times for each group, were significantly different (p=0.03). The mean revolution per minute(RPMs)or the two groups were also significantly different (p=0.05). CONCLUSIONS: Our results suggest that microdrills used in endonasal dacryocystorhinostomy should have protective shields to minimize mucosal damage, and employ rapid RPMs to efficiently produce bony openings in the thick anterior processes of the maxilla. The tips of microdrills should also be exposed, to better visualize and acquire good operating fields.

Diagnosis and Treatment of Lacrimal Passage Obstruction by Lacrimal Endoscope / 华中科技大学学报（医学）（英德文版）

The diagnosis and treatment of the lacrimal passage obstruction with lacrimal endoscope was investigated and its subsidiary surgical procedures were evaluated. Ninety-three patients (109 eyes) with lacrimal passage obstruction, including presaccal canalicular obstruction (PSCO) and na-solacrimal duct obstruction (NLDO), were examined under a lacrimal endoscope, and the obstruc-tions were treated with laser or micro-drill. All patients were followed up after the operation for 3-6 months. The difference between the laser and the micro-drill treatment was observed. During the pe-riod of follow-up, the curative rate was 82.57%. The healing rate in PSCO group and NLDO was 80.36% and 84.91% respectively (P>0.05). After treatment with the laser, the healing rate was 93.33% in the PSCO group and 66.67% in the NLDO group respectively (P<0.05). After treatment with the micro-drill, the healing rate in PSCO and NLDO groups was 65.39% and 94.28% respec-tively (P<0.01). The lacrimal passage obstruction can be observed and treated directly through the lacrimal endoscope. Choosing different surgical procedures in operation according to the locations of the obstruction is helpful to improve the effectiveness.

A Clinical Study on the Endonasal Microdrill-assisted Dacryocystorhinostomy

As noe of causes of epipora, anatomic abnormality of nasolacrimal duct, has been treated with dacryocystorhinostomy. Recently, the development of nasal endoscopy has made it easy to observe the intranasal sturcture. Thus, authors investigated the effect of nasal endoscopic dacryocystorhinostomy used in combination with microdrill and nasal endoscopy in those patients, with nasolcrimal obsturction at the time of dacryocystorhinography. From 1995 to April 1997, twenty-four patients have been treated by the intranasal dacryocystorhinostomy using the microdrill with follow up more than six months. All patients had been tested by preoperative intranasal exam and was measured radiologically preoperative`s size of lacrimal sac. The nasal endoscopy using microdrill had shown success rate of 83.3 percent and the surgerywas more successful as the size of preoperative lacrimal sac was larer without any complication. The formation of accurate bone foramen did not remarkably differ from the skin incisio at the time of operation. Therefore, dacryocystorhinostomy using microdrill can be useful for the treatment of lacrimal canal obstruction, especially with the proper operating equipment.