Endonasal Dacryocystorhinostomy II. (Analysis of 208 Operations)

Overview

The authors present a group of 208 primary endonasal dacryocystorhinostomies(EDCR) which the performed in 1995-2000. Indication for surgery in children was most frequentlyinborn obstruction of the lacrimal ducts, in adults idiopathic obstruction of the lacrimal ducts.Twelve times the authors detected a dacryolith. From 167 subsaccal and saccal obstructions theyachieved cure or improvement in 153 cases, i.e. in 91.6%, in combined subsaccal and saccal obstructions in 17 instances, i.e. in 58.6%, of 12 suprasaccal obstructions only in four instances, i.e. 33.3%.As compared with adults, in the child patients the results were not worse. The most frequentcomplication was the development of postoperative haematoma of the eyelid and emphysema of theeyelids.The authors analyze the effect of auxiliary operations on the resultof EDCR. Most effective isresection of the head of the median concha where they achieved cure in 38 of 39 cases. If the resectionof the head of the concha was combined with anterior ethmoidectomy 20 of 23 cases were cured. Animportant influence is ascribed to the use of cannicular silicone stents. As however the stents wereused in complicated cases in children it was not possible to make a valid comparison of the groupwith and without a stent. The limiting factor for more frequent use of a stent can be also their price.In the discussion the authors present their own experience with EDCR. The authors use fortrepanation of the bone more frequently a chisel, when thereis a risk of ciccatrization of the stomaand a prominent head of the median concha they are in favour of its resection. For detection of theprojection of the lacrimal sac on the lateral wall they use most frequently bayomet forceps.

Key words:
endonasal dacryocystorhinostomy, results, resection of the head of the medianconcha, stents.