Epiphora drainage by DCR – Long-term results

ABSTRACT

Background: Dacryocystorhinostomy (DCR) refers to the surgical procedure that is used to relieve the chronic obstruction of the nasolacrimal duct obstruction (NLDO). In a maxillofacial setting, NLDO may arise subsequent to a facial trauma or orthognathic surgery. There is a dearth of literature from this part of the world. This article intends to provide a single maxillofacial center experience in DCR. Materials and Methods: This is a retrospective, noncomparative, noninterventional, record audit type of study of all consecutive patients fulfilling inclusion and exclusion criteria. All patients with epiphora and diagnosed with lacrimal apparatus damage between 1 January 2008 and 31 December 2017 requiring DCR were considered for the study. Details of demographics, phase of treatment (primary/retreatment), types of bones involved, age, complications, period suffering from epiphora, and follow-up were obtained. All data were entered and analyzed using the Statistical Package for the Social Service (version 16; IBM). Descriptive statistics of the frequency and mean ± standard deviation (SD) as appropriate were presented. Chi-square test and one-way analysis of variance were used appropriately. P ≤ 0.05 was taken to be statistically significant. Results: In all, 83 patients fulfilled the inclusion and exclusion criteria. It is more common in males (n = 56, 67.47%) with a mean ± SD of 32.24 ± 10.80 (18–59 years) with 27 (32.53%) of them presenting primarily after fractures. Fracture was the most common pathology seen in 81.93% (n = 68) of cases, while the rest were as a result of orthognathic cases. Le Fort II and III set of bones contributed to 59% of cases, while the orbitonasal complex contributed to only three cases. NLD obstruction was seen in 68 (81.9%) of cases. On an average, the patients suffered for 9.3 ± 6.74 months (range 0.5–22 months) before seeking treatment and the average follow-up was 31.07 ± 11.69 months (range 15–54 months). Discussion and Conclusion: Fractures and surgeries involving nasal bones carry an innate risk of damaging the NLD system. The pattern of need for DCR and occurrence of NLDO in this part of the world have been described. The extent of the anatomical variations and need for proper surgical planning are highlighted.