Endoscopic dacryocystorhinostomy: the keys to surgical success.

PURPOSE: To describe a surgical technique for endoscopic endonasal dacryocystorhinostomy. METHODS: A consecutive case series of adult endoscopic dacryocystorhinostomy surgery was reviewed. The specific surgical approach of uncinectomy with or without septoplasty and anterior middle turbinectomy was noted. Postoperative follow up including endoscopic examination and results were documented. RESULTS: A total of 300 cases were included (271 patients) with average age of 66 (range 24-94). An uncinectomy was performed in 285 of 300 (95%) cases, a septoplasty in 82 of 300 (27%) cases and an anterior middle turbinectomy performed in 225 of 300 (75%) cases. Postoperative bleeding that required nasal packing occurred in 2 of 300 (0.6%) cases. Persistent nasolacrimal symptoms after surgery occurred in 18 of 300 (6.0%) cases with an average follow up of 28 months (range 1-70). Postoperative nasolacrimal symptoms were attributed to a persistent lacrimal sac (sump syndrome) in 1 of 300 (0.3%) cases, a mucocele recurrence in 2 of 300 (0.6%) cases, and scarring at the rhinostomy in 15 of 300 (5.0%) cases. CONCLUSIONS: Endoscopic endonasal dacryocystorhinostomy is an effective treatment for nasolacrimal duct obstruction. An uncinectomy, septoplasty, and anterior middle turbinectomy contribute to the optimal clearance of the common canaliculus and ultimate surgical success.

Pushed monocanalicular intubation: an alternative stenting system for the management of congenital nasolacrimal duct obstructions.

PURPOSE: To present our experience with a "pushed" monocanalicular nasolacrimal intubation device in the management of nasolacrimal duct obstruction in children. METHODS: The cases of consecutive patients with nasolacrimal duct obstruction who were treated with primary probing and intubation with the Masterka were reviewed retrospectively. The Masterka includes a metal guide placed inside a silicone tube for "pushed" intubation as opposed to material attached at the distal end of the silicone for intranasal retrieval ("pulled" intubations). All procedures were accomplished with the patients receiving masked airway anesthesia; neither laryngeal mask airway nor endotracheal intubation was necessary. Only patients noted to have a membranous (mucosal) obstruction were considered for treatment with the Masterka. The duration of operation, duration of stent intubation, and severity of symptoms on follow-up were noted. Success was defined as absence of symptoms after stent removal or loss. RESULTS: A total of 110 eyes of 88 patients were included (average age, 2.4 years; range, 1-8 years). The average operating time was 3 minutes (range, 2-9 minutes). Persistent tearing on follow-up with the stent in place was noted in 26 eyes (24%); tearing resolved after stent removal in 19 eyes (73%). Success was achieved in 94 eyes (85%). with an average follow-up of 33.7 weeks (range, 4-139). Keratitis was noted in 2 eyes (2%). Early stent loss occurred in 17 ducts (15%). CONCLUSIONS: The Masterka was an effective primary treatment for nasolacrimal duct obstruction associated with mucosal obstructions in this small series of patients.

Ptosis forceps with a protected lock: A new device in oculoplastic surgery.

The authors describe a new device for oculoplastic surgery, a so-called ptosis forceps with a protected lock, which greatly facilitates dissection of the levator muscle in ptosis operations as well as in levator recession procedures. The instrument consists of an inferior part, including two grooved atraumatic flat jaws, and a superior part, including a bulging rough area and a smooth tapered tip. The original feature of this new device is its hidden lock mechanism, located between the two bulging parts of the forceps, in such a way as to free the instrument(1)s outer surface, thus making grasping and release of the levator muscle easier during surgery.