ABSTRACT
Dacryocystorhinostomy is a procedure that is performed to allow drainage of tears from the lacrimal sac directly into the nasal cavity. Endonasal telescopes facilitate performance of this operation with better visualization and decreased morbidity. We present our experience with endoscopic laser-assisted DCR. In the last 31 months, we have performed 31 procedures on 23 patients with either the holmium:YAG laser or the argon:HGM laser. We have a 97% overall success rate with a mean follow-up of 16 months. Our series includes both adult and pediatric patients as well as five revision procedures after failed external DCR. We present our technique, results, and the reasons for our change in laser delivery systems. Most importantly, we discuss the technical factors that contribute to our overall success. These include a large rhinostomy size, simultaneous correction of intranasal and/or sinus pathology, the avoidance of laser use within the lacrimal sac, and close postoperative monitoring with intranasal debridement. We conclude that endoscopic laser-assisted DCR is a better alternative to standard external DCR because it avoids a cutaneous scar, excessive tissue injury, and postoperative morbidity.
Subject(s)
Dacryocystorhinostomy/methods , Laser Therapy/methods , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Dacryocystorhinostomy/instrumentation , Female , Humans , Laser Therapy/instrumentation , Male , Middle Aged , Reoperation , Treatment OutcomeSubject(s)
Dental Care/adverse effects , Dental High-Speed Equipment/adverse effects , Pharyngeal Diseases/etiology , Subcutaneous Emphysema/etiology , Anti-Bacterial Agents/therapeutic use , Deglutition Disorders/etiology , Female , Humans , Middle Aged , Pharyngeal Diseases/diagnostic imaging , Pharyngeal Diseases/drug therapy , Radiography , Subcutaneous Emphysema/diagnostic imaging , Subcutaneous Emphysema/drug therapyABSTRACT
Postoperative hypocalcemia was studied in 40 patients undergoing total thyroidectomy for a malignancy or massive goiter. Parameters evaluated included serum calcium, phosphate and magnesium levels. All patients exhibited a postoperative decline in serum calcium, however, the lowest serum calcium level was not seen until 48 hours after surgery. Serum calcium levels returned to normal in five to six days after surgery in 37 patients. Five patients required calcium supplementation for either symptomatic hypocalcemia or serum calcium levels lower than 7.0 mg/dl. Only three of these five patients were discharged home on oral calcium supplements. In this series, we discovered that the critical period for monitoring of serum calcium was 24 to 96 hours after surgery. If serum calcium replacement was not needed in the first 72 hours after surgery, it would not be needed during the remainder of the patient's hospital course. In addition, we found that serum magnesium levels should also be monitored in the postoperative period and corrected if low.
