Endonasal dacryocystorhinostomy in children: Our experience.

INTRODUCTION: Epiphora affects approximately 20% neonates, but most resolve spontaneously. Dacryocystorhinostomy (DCR) is indicated only when conservative management fails. OBJECTIVE: To observe clinical presentation, treatment modalities and effectiveness of endoscopic DCR in paediatric population. METHODS: It is a prospective study of 21 children done at our tertiary care hospital from 2011 to 2016. All were initially subjected to a trial of conservative management. Those that responded and didn't require surgery were excluded. RESULTS: The age group ranged from 40 days to 11.5 years. 19 underwent unilateral & 2 underwent bilateral endoscopic DCR. After a 6 month follow-up, 20 children were benefitted by surgery, 2 had an incomplete resolution and 1 required revision surgery. The overall success rate was 95.23% and failed cases were mainly due to post-traumatic distortion of the anatomy. No major complications were noted. CONCLUSION: Endoscopic DCR is safe and effective in children presenting with persistent epiphora.

Paediatric endonasal dacryocystorhinostomy using an otology set: How I do it.

INTRODUCTION: Endonasal DCR is safely performed in children presenting with persistent epiphora, not responding to conservative management. The surgical technique of endoscopic DCR in the paediatric age group essentially remains the same as that performed in adults, but children have narrower nasal passages and relatively larger inferior turbinates which limit the surgeon's working space. The standard 2.7 mm paediatric nasal endoscope gives a smaller surgical work field as compared to the 4 mm adult endoscope. Hence, we have used the otology set of instruments for performing endoscopic DCR in children to allow the negotiation of a wider 4 mm scope which gives a larger field of surgery and better illumination. MATERIALS AND METHODS: It is a prospective study of 23 children done over the last 5 years at our tertiary care hospital. We have successfully used this less invasive technique of endoscopic dacryocystorhinostomy who didn't respond to conservative management. RESULTS: The overall success rate was 95.65% without any major complications. CONCLUSION: Using the fine delicate otology set for endonasal DCR is advantageous as it not only allows the use of a 4 mm endoscope but also allows the surgeon to perform a more meticulous surgery by preventing unnecessary mucosal abrasions and creation of raw areas thereby improving surgical outcome. It thus combines a high success rate with a lesser invasive technique. At the same time, it is important to have an experienced surgeon due to the variable anatomy and technical accuracy required in children.