Conventional DCR vs DCR implant method in chronic dacryocystitis

Background: Chronic dacryocystitis is the commonest cause of lacrimal passage obstruction indicates inflammation of lacrimal sac. Dacryocystorhinostomy (DCR) is the preliminary choice of surgical procedure in which lacrimal sac is connected with nasal mucosal flap by bypassing nasolacrimal duct. Objectives: This comparative study described and evaluated the effectiveness of conventional D.C.R method and D.C.R implant method in chronic dacryocystitis cases. Materials and methods: The present comparative study consisted of 200 patients with complaint of watering, pus discharge and diagnosed as chronic dacryocystitis. Out of which 160 cases were followed up for a period of 3-6 months. Study cases were operated by using “Pawar implant”. Results: Bleeding occurred during operation was much more in conventional D.C.R. (53.3%) method than D.C.R. implant method (7.7%). Complete patency of nasolacrimal duct was observed in 125 cases i.e. 76 cases in D.C.R. implant method, 35 cases in Conventional D.C.R. method and 14 cases in D.C.R implant after D.C.T done. Partial patency of naso lacrimal duct was observed in 22 cases and failure of patency was seen in 11 cases. Conclusion: D.C.R implant (Pawar Implant) method is secure, minimal time consuming, needs little incision, little bony ostium and less painful surgical modality for chronic dacryocystitis than conventional D.C.R method.

A Case of Fungal Ball Causing Acute Dacryocystitis

PURPOSE: We report a case of fungal ball after Endoscopic Dacryocystorhinostomy (DCR) in a 40-year-old female patient. CASE SUMMARY: A 40-year-old female patient was admitted to our hospital for left lower eyelid tenderness and bloody discharge from the lacrimal punctum. During a planned endoscopic DCR, the sac was opened after the osteotomy, and 2 fungal balls were found in the lacrimal sac. The masses were 7 × 5 mm and, 9 × 5 mm sized, irregularly shaped, and red in color. Aspergillus fumigatus was diagnosed pathologically. Postoperative paranasal sinus magnetic resonance imaging showed no residual fungal ball. During follow-up, the patient showed patent rhinostomy opening, and there was no evidence of fungal infection on nasal endoscopic finding. CONCLUSIONS: Although Aspergillus fumigatus is a rare cause of canalicular obstruction, fungal ball development in the lacrimal sac can cause acute dacryocystitis.

Prognostic Factors Associated with Surgical Time of Endonasal Dacryocystorhinostomy

PURPOSE: To determine the prognostic factors associated with surgical time of endonasal dacryocystorhinostomy (DCR). METHODS: From April 2009 to June 2014, 66 eyes of 66 patients who underwent endonasal DCR for 5-year periods were retrospectively evaluated with regard to surgical time and several other factors. The factors were patient factors (age, sex), category of diagnosis (inflammation and non-inflammation), and systemic factors (diabetes mellitus [DM], hypertension [HTN], anticoagulant agents, sinusitis history). We divided the study period into three subperiods and compared their surgical time. The anatomical factor of thickness of the maxillary frontal process was evaluated by computed tomography (CT), as was the existence of symptom recurrence after surgery and reoperation according to surgical time. A total of 66 cases (right: 31, left: 35) were included. Any case with concurrent surgery, abnormal structure of the nasal cavity, or bilateral DCR was excluded. RESULTS: Average surgical time was 49.95 minutes. Surgical time of endonasal DCR was short in inflammatory cases (p = 0.047), in the third surgical period (p = 0.001), and was correlated with thickness of the maxillary frontal process (p = 0.001). In addition, surgical time correlated with the existence of symptom recurrence after surgery and reoperation (p = 0.012). CONCLUSIONS: It is considered that surgeon skill affects surgical time, and the thickness of the maxillary frontal process by CT will aid in the prediction of surgical time and success rate of endonasal DCR.

Management of Nasolacrimal-Cutaneous Fistula – A Maxillofacial Review and Sharing Experience.

Nasolacrimal cutaneous fistula can be presented with a complaint of discharge from an opening found below the eye and beside the nose. The patient’s history can be remarkable with repair of severe maxillofacial injuries. Examination reveals a nasolacrimal-cutaneous fistula extending from lacrimal sac to the overlying skin with co-existing nasolacrimal duct obstruction. To correct a lacrimal-cutaneous fistula, an endoscopic dacryocystorhinostomy should be performed to create a new opening to the lacrimal apparatus medially. Simultaneous irrigation and probing of the common canaliculus and fistula tract under direct visualization allows identification of the origin of the lacrimal fistula in relation to the internal ostium on the lateral lacrimal sac wall. Post-traumatic nasolacrimal disturbances are not uncommon findings in trauma patients and management of these chronic fistulas may be helpful for complete rehabilitation of the patient.

Analysis of the Results Endonasal Dacryocystorhinostomy Related to Nasal Cavity State

PURPOSE: This study evaluated the relationship of nasal cavity state and surgical results after endonasal dacryocystorhinostomy (DCR). METHODS: We retrospectively analyzed 306 eyes of 204 patients between January 2007 and December 2011. The correlation between the existence of preoperative nasal cavity abnormality, postoperative nasal cavity complications after proper management of nasal cavity abnormality, and postoperative nasal cavity complications according to nasal packing material were investigated. We analyzed the success rates and the correlation between each set of factors. RESULTS: The success rate of primary operations performed six months after tube removal was 87.3% (267/306). The success rate after secondary revision, granuloma removal and punctoplasty was 90.5% (277/306). Postoperative nasal cavity complications were inspected in 40 eyes. Of the 306 eyes, patients treated with Nasopore showed significantly more postoperative nasal cavity complications (47.8%, 32/67) than in patients treated with Merocel (3.3%, 8/239). The rate of postoperative nasal cavity complications was 8.7% in patients with normal nasal cavity, 16.7% in patients who received treatment, and 20% in patients without treatment, with significant statistical increase if the nasal cavity was abnormal (p = 0.019). The incidence of complications influenced the primary success rate (p = 0.008); however, preoperative nasal cavity abnormalities were not correlated with primary success (p = 0.479). CONCLUSIONS: In the case of endonasal DCR, preoperative nasal cavity abnormality and type of nasal packing material used did not affect the success rate but significantly affected postoperative nasal cavity complications. In conclusion, endonasal DCR with preoperative treatment of nasal cavity abnormality and Merocel packing is expected to reduce postoperative nasal cavity complications and increase patient satisfaction.

Analysis of the Results Endonasal Dacryocystorhinostomy Related to Nasal Cavity State

PURPOSE: This study evaluated the relationship of nasal cavity state and surgical results after endonasal dacryocystorhinostomy (DCR). METHODS: We retrospectively analyzed 306 eyes of 204 patients between January 2007 and December 2011. The correlation between the existence of preoperative nasal cavity abnormality, postoperative nasal cavity complications after proper management of nasal cavity abnormality, and postoperative nasal cavity complications according to nasal packing material were investigated. We analyzed the success rates and the correlation between each set of factors. RESULTS: The success rate of primary operations performed six months after tube removal was 87.3% (267/306). The success rate after secondary revision, granuloma removal and punctoplasty was 90.5% (277/306). Postoperative nasal cavity complications were inspected in 40 eyes. Of the 306 eyes, patients treated with Nasopore showed significantly more postoperative nasal cavity complications (47.8%, 32/67) than in patients treated with Merocel (3.3%, 8/239). The rate of postoperative nasal cavity complications was 8.7% in patients with normal nasal cavity, 16.7% in patients who received treatment, and 20% in patients without treatment, with significant statistical increase if the nasal cavity was abnormal (p = 0.019). The incidence of complications influenced the primary success rate (p = 0.008); however, preoperative nasal cavity abnormalities were not correlated with primary success (p = 0.479). CONCLUSIONS: In the case of endonasal DCR, preoperative nasal cavity abnormality and type of nasal packing material used did not affect the success rate but significantly affected postoperative nasal cavity complications. In conclusion, endonasal DCR with preoperative treatment of nasal cavity abnormality and Merocel packing is expected to reduce postoperative nasal cavity complications and increase patient satisfaction.

Repeat DCR with Silicone Tube Intubation : A Prospective Study

Forty patients who were operated upon for chronic dacryocystitis six months to two years before presented with history of persistent watering and discharge. Repeat DCR with silicone tube intubation was performed in all the patients. Post-operative follow-up for a period of 12-18 months revealed absence of symptoms in 38 patients while 2 patients persisted with watering and discharge despite uncomplicated surgical procedure.

Clinical Evaluation of Endoscopic Transnasal Dacryocyocystorhinostomy

The purpose of our study was to evaluate the effectiveness of endoscopic transnasal dacryocystorhinostomy(DCR) in patients who had lacrimal obstruction. Between June 1995 and December 1996, 19 patients(20 eyes) who had undergone endoscopic transnasal DCR were evaluated for follow up of at least 3 months. All patients were preoperatively examined by an otolaryngologist. Eleven cases were operated on intranasal diseases(sinusitis, septal deviation, enlarged middle turbinate) at the same time. Lacrimal obstruction was completely relieved in 16 patients (80%) for a follow-up of 3 months. Granulation was formed in 4 patients after 3months. There were two postoperative complications including bleeding and periorbital swelling on the first day after operation. In conclusion, endoscopic tansnasal DCR appears to be a safe, effective procedure which should be considered as an alternative to conventional external DCR for the surgical treatment of nasolacrimal duct obstruction.