Dacrocystorhinostomy in Children with Obstruction of the Lacrimal Pathways

Overview

The authors present an analysis of 23 endonasal endoscopic dacrocystorhinostomies (EEDCR) and onedacrocystorhinostomy from an external approach (EXT-DCR), implemented in 1996 - 1999 in 21 children. Theyoungest child was 8 months old, the oldest 13 years, the mean age being 4.5 years. The cause of obstruction of thelacrimal pathways was in 19 children congenital obstruction of the lacrimal pathways, in 6 instances associatedwith chronic dacrocystitis: twice obstruction after a dog bite was involved. Indicati on for surgery was subsaccalobstruction (16x) or a combination of subsaccal and suprasaccal obstruction (6x), in two instances suprasaccalobstruction. Six children had before DCR an unsuccessful intubation of the lacrimal pathways.The operation proper was in all instances made under general anaesthesia. A bilateral operation was made inthree children. In primary operations a stent was used 19x, and in all reoperations. With the exception of two caseswhere penetration into the orbit occurred, antibiotics were not administered as a standard procedure.The outcome was evaluated six months after surgery based on subjective evaluation and by means of FDDT(Fluorescein Dye Diasappearance Test). A total of 23 DCR were evaluated (one patient did not attend the check-upexamination). EXT-DCR was successful, in primary EEDCR 18 cases of 22 were successful. Thus primarily curewas achieved in 20 of 23 cases (87.0%). Of 16 subacute obstruction primary DCR was successful in 15 (93.8%), of5 combined subsaccal and suprasaccal obstructions in three cases (60.0%), one suprasaccal obstruction wassuccessful. Three patients where the primary operation was not successful were re-operated by the endonasal routeand the result was good. From the total number of operations, incl. re-operations, 23 cases of 23 operated oneswere successful (100.0%).The lower range for operation is according to the authors 6 - 8 months of age. If it is possible, they prefer beforeDCR intubation of the lacrimal pathways. EXT-DCR and EEDCR, due to the small size of the nasal cavity, callfor a very careful approach to the nasal mucosa and because of poorer postoperative cooperation it is useful to

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