Modification of Endoscopic Dacryocystorhinostomy in Chronic Dacryocystitis
The aim of the study was to assess the efficacy of endosurgical treatment of chronic dacryocystitis using modified endoscopic dacryocystorhinostomy by analyzing the short-term and remote results.
Materials and Methods. In the period from 2012 to 2018, 120 operations for chronic dacryocystitis, 87 of which were endoscopic endonasal dacryocystorhinostomias (EEDCR), have been performed in the Clinic of Eye Diseases and ENT Clinic at Nizhny Novgorod Regional Clinical Hospital named after N.A. Semashko. Chronic dacryocystitis was caused by stenosis of the nasolacrimal ducts. Women prevailed in this cohort of patients. The age of the patients ranged from 23 to 82 years. Of 87 patients undergone EEDCR, 45 had phlegmon of the lacrimal sac in the medical history.
The operations were performed under intubation anesthesia. Eight patients were subjected to nasal septum correction as a first stage of surgical treatment.
All patients were seen for dynamical followed-up visits 15, 30, 90, and 180 days after the surgical intervention with obligatory examination of the nasal cavity and flushing of the lacrimal passages.
Results. In 79 patients (90.8%) patency of the lacrimal ducts was restored. In 16 individuals (18%) there was recurrence of dacryocystitis at different terms (1 to 6 months) requiring repeated operations. The recurrent episodes were related to the specific anatomy of the nose cavity, in particular, due to a proximal location of the middle nasal concha to the junctionary. A complex examination of patients with dacryocystitis allows ophthalmologists or ENT specialists to avoid mistakes in establishing the diagnosis and reduce intraoperative and postoperative complications. A two-step operation technique (correction of the nasal septum curvature and dacryocystorhinostomia) makes it possible to improve visualization of the operative field, reduce the risk of recurrences, diminish anesthesiological load and stress for the patient. Preliminary diathermocoagulation of the nasal mucous membrane prior to flap dissection on the lateral wall reduces bleeding during the operation. Transcanalicular interoperative illumination of the lacrimal sac projection enables surgeons to choose precise junctionary topography.
Conclusion. A modified EEDCR with transcanalicular illumination of the lacrimal sac and preliminary diathermocoagulation of the nasal mucous membrane in the lacrimal sac projection is an effective surgical treatment of dacryocystitis, while preoperative examination by the ENT specialist and computed tomography of the paranasal sinuses and ethmoidal labyrinth provide the opportunity to adequately plan the operation and decrease the recurrence rate.
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