Our practice serves manchester uk, cheshire uk, london uk and surrounding areas. Exdcr was first described by toti in 1904 and is the most widely practiced procedure. Ocular surgery news posed the following question to a panel of experts. Silicone stenting and polypropylene stenting in endoscopic dacryocystorhinostomy. Twentytwo of the 24 dcrs were patent after a mean followup of 21. A comparison of external and endoscopic endonasal dacryocystorhinostomy for acquired nasolacrimal duct obstruction r karim, r ghabrial, tf lynch, b tangschool of public health, faculty of medicine, university of sydney, sydney, australiapurpose. Dacryocystorhinostomy dcr is indicated for patients who suffer from chronic epiphora tearing from the eye onto the face or dacryocystitis infection of the tear sac, due to nasolacrimal duct. Dacrocystorhinostomy dcr is an operation used to treat nasolacrimal duct obstruction. A total of 24 procedures were performed using a standardized surgical technique. Compared with external dcr, endoscopic dcr is more expensive, with high equipment costs. The operation is very similar to external dcr, except there is no cut through the skin and no scar afterwards. Endoscopic vs external dacryocystorhinostomycomparison. Most of the studies conducted of endoscopic dcr have a recorded a success rate of around 80%7, 8, 9, 10 which is lower than external dcr success rate of which are around 90%11, 12, 14.
Endonasal dcr broadly refers to the approach from inside the nose, including the speculum or endoscope view. Silicone stenting and polypropylene stenting in endoscopic. To compare success rates of external dacryocystorhinostomy dcr and endoscopic endonasal dcr for acquired nasolacrimal duct. However, it is your decision to go ahead with the operation or not. Revision endoscopic dacryocystorhinostomy sciencedirect.
At first glance the ostium appears large and patent. Despite much debate, many still believe that external dcr provides a high success rates than endoscopic dcr though many types of endonasal approaches have been attempted, long term success rates are less than ext. To analyze endoscopic endonasal dacryocystorhinostomy endo dcr cases regarding the problems encountered during the procedure, post operative complications, their management and success rate. Endoscopic dacryocystorhinostomy dcr is used to treat patients diagnosed with lacrimal sac or nasolacrimal duct obstruction nldo. Leatherbarrow specializes in endoscopic dcr, eye lid surgery and tear drainage surgery. The basic indication is same in all cases and either route can be used. It allows a onestage procedure to also correct associated nasal pathology that may be causative. Outcome and complications of endoscopic dacryocystorhinostomy. A small incision is made on the side of the nose and some bone is removed to make a connection to the nose.
This video shows the endoscopic revision of a patient with late failure of an endoscopic dcr. Lacrimal sac compression by an anterior ethmoidal mucocele. Paediatric endoscopic and external dcr have similar success rates of around 8396%. Is endoscopic dacryocystorhinostomy dcr the new standard for nasal lacrimal duct surgery, or.
Endoscopic dcr is minimally invasive and efficaceous procedure for nasolacrymal obstructions performed by otorhinolaryngologist and ophtalmologist. Dcr can either be achieved through an endoscopic approach usage of instruments and a small telescope through the nasal cavity or from an endoscopic approach usage of a small facial incision. A total of 105 patients with epiphora secondary to acquired nasolacrimal duct obstruction were operated on by our modified powered endoscopic dacryocystorhinostomy approach. Recent developments have allowed the manufacture of endoscopes inexpensive enough to be used on a single patient only. Persistent epiphora was found in 43% of children and recurrent dacryocystitis in 57%. Endonasal endoscopic dacryocystorhinostomy in children. This procedure aims at the bypass of obstructed nasolacrimal duct and allowing tear drainage into the nasal cavity directly from the lacrimal sac. To compare the success and complication rates, duration of surgeries and clinical comfort after endoscopic dacryocystorhinostomy enddcr or external dacryocystorhinostomy extdcr. Endoscopic dcr is one of the several techniques to unblock the nasolacrimal duct. The key to the improved success rates achieved with endoscopic dcr is to attempt to. Objective to report revision external dacryocystorhinostomy redcr results following failed dacryocystorhinostomy dcr surgery. The endoscope is introduced into the left nares where the middle turbinate and middle meatus are noted. Rates for success for endoscopic dacryocystorhinostomy dcr ranges from 70% 4 to 95%5,6,7. Inferiorly, the inferior turbinate is demonstrated.
Since 1904 5, the surgical management accepted for this disease was the external approach, although caldwell 6 was the first to propose, in 1893, the endonasal approach, unfortunately limited by the technology, at that time. A dcr file is an interactive media file saved in the shockwave format for distribution on the web. The evaluated results were considered as successful if the epiphora decreased, infections were reduced, or reflux from the canaliculus was absent during lacrimal irrigation. Endoscopic dacryocystorhinostomy dcr is indicated when medical therapy has failed to achieve resolution of the disease. Tearing is most commonly due to a blockage or narrowing of the nasolacrimal duct. Overview endoscopic dacryocystorhinostomy guidance nice. During their study ambani et al 1 noted that the failure of endoscopic dcr especially in cases where no stent was used, were because of granulations. The national institute for health and clinical excellence nice has issued full guidance to the nhs in england, wales, scotland and northern ireland on endoscopic dacryocystorhinostomy.
A comparison of endonasal dacryocystorhinostomy and external. It avoids injury to the medial canthus scar formation. Endoscopic sinus surgery anatomy three dimensional reconstruction and surgical technique. Revision external dacryocystorhinostomy results after a. Virtual reality simulators are being developed for training doctors on various endoscopy skills. However, with all the advantages endoscopic dcr provides it is essential to develop a technique which could increase the success rate of this surgery. Role of silicon stent in endoscopic dcr international. Endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction. Keys to successful dcr adequate rhinostomy clear common canalicular opening superior and inferior adequate marsupialization of the lacrimal sac removal of anatomic obstruction eg, septoplasty american academy of ophthalmology. Amongst many others, we support png, jpg, gif, webp and heic. Endoscopic dacryocystorhinostomy dcr is a surgical intervention for epiphora caused by obstruction of the nasolacrimal duct. Objective to describe the indications, technique, and results of endonasal endoscopic dacryocystorhinostomy in children with congenital and acquired disorders of the nasolacrimal system design retrospective case series setting tertiary care hospital patients four children ranging in age from 10 months to 6 years. Welcome,you are looking at books for reading, the endoscopic sinus surgery anatomy three dimensional reconstruction and surgical technique, you will able to read or download in pdf or epub books and notice some of author may have lock the live reading for some of country.
Endoscopic sinus surgery anatomy three dimensional. This video demonstrates an endoscopic dacryocystorhinotomy dcr. Dcr is also used for congenital nldo when probing and irrigation, silicone intubation, or. To compare a composite technique of endoscopic dacrocystorhinostomy with the conventional technique. However, on closer endoscopic examination there is a fold within the lacrimal sac 108. The nasolacrimal duct tends to narrow with age, but this process is probably exacerbated by persistent infections and can occur earlier in life see tearing in children. These results are similar to those achieved with external dcr8,9. You can use the options to control image resolution, quality and file size.
External dacryocystorhinostomy is a gold standard traditional surgical approach to treat nasolacrimal duct obstruction. It preserves the pumping mechanism of the orbicularis oculi ms active infection of the lacrimal system is not a contraindication to endoscopic surgery. Overall, three groups of procedures are currently practised. Original article problems complications, success rate. Endoscopic transnasal dacryocystorhinostomy volume 103 issue 6 m. Endoscopic dacryocystorhinostomy bjorl brazilian journal of. Postoperatively, symptom evaluation and endoscopic assessment of the newly created lacrimal ostium were done.
In operations 30% a septoplasty was required at the time of surgery, and in 10 operations 23% further endoscopic sinus surgery was performed in conjunction with the dcr. Conventional dacryocystorhinostomy versus endonasal. Recurrent infection may also occur as a result of the stagnation. The dacryocystorhinostomy operation, which involves fistulization of the lacrimal sac into the nasal cavity, may alleviate the symptoms. Dcr can be performed either through a cutaneous incision external dcr, or extdcr or transnasally under direct visualization or endoscopic guidance endoscopic dcr, or edcr. They finally pass through lacrimal sac to nasolacrimal duct.
Endoscopic dcr is also technically more difficult to learn, and there is a definite learning curve. The endonasal surgical approach of the lacrymal sac assisted by videoendoscopy is carried out today with high success rates. It can be done with external ex or endonasal en access. All the patients underwent endoscopic dcr with silicon stent placement. Dcr is sometimes required for paediatric congenital or acquired nasolacrimal duct obstruction. Understanding endonasal anatomy, wide endoscopic marsupialisation of the lacrimal sac, and meticulous care of the nasal mucosa are important to achieve good results. Although external dcr was considered to be the gold standard treatment for nld obstruction, endoscopic dcr appears to give comparable results, with the advantage of the absence of.
Surgical instruments or a laser are used to create an opening between the nose and the lacrimal sac through the mucosa and intervening bone. Endoscopic dacryocystorhinostomy in functional lacrimal obstruction. Disposable endoscopy is an emerging category of endoscopic instruments. Endoscopic dacryocystorhinostomy dcr vula university of. Therefore, the complication rate to be expected remains low. Endoscopic dcr eye lid surgery tear drainage surgery. Endoscopic ultrasonic dacryocystorhinostomy for recurrent. Endo dcr, done from jan 2008 to sep 2011 in eye departments of cmh kharian and mardan, were analyzed in this retrospective. Powered endoscopic dacryocystorhinostomy with mucosal.
Saratziotis a, emanuelli e, gouveris h, babighian g. An endoscopic dcr dacryocystorhinostomy is an operation to treat a blocked nasolacrimal duct or sac. Clinical practice guidelines for enhanced recovery after. In general, endoscopic management of dcr failure has been shown to have excellent results, ranging from 76% to 91% success. Endoscopic dcr endoscopic dcr is a minimally invasive procedure to unblock tear ducts. Both kerrison punch and drill are widely used in endoscopic dcr with nonconclusive knowledge about. Endoscopic transnasal dacryocystorhinostomy the journal.
Pooled results showed that both surgical approaches had similar success rates endoscopic endonasal dcr 82. Access is through your nose, using a small thin camera endoscope. This narrated video focuses on the challenges of and surgical technique for paediatric endoscopic dcr surgery. It is often used for creating web games and other highly. Dacryocystorhinostomy dcr is the standard treatment for nasolacrimal duct obstruction1. Dacryocystorhinostomy dcr is a surgical procedure to restore the flow of tears into the nose from the lacrimal sac when the nasolacrimal duct does not function. Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the american society of colon and rectal surgeons and society of american gastrointestinal and endoscopic surgeons. Advantages of endoscopic dcr it provides better aesthetic result with no external scar. Epiphora, or abnormal tearing, occurs because of blockage in the lacrimal drainage system, which impairs normal tear channeling into the nose. Thirty patient selected for endoscopic dcr were divided into two groups, one of which underwent conventional endoscopic dcr and the other group were treated with a newer technique using cautery, cold instrumentation and laser at different steps of endoscopic dcr. Endoscopic dacryocystorhinostomy with silicone stenting. Nasolacrimal duct opens into anterior part of outer wall of inferior meatus. Endoscopic dacryocystorhinostomy videos oculoplastic. The endonasal surgical approach of the lacrymal sac assisted by video endoscopy is carried out today with high success rates.
About this document we understand this can be a stressful time as. Endoscopic dacryocystorhinostomy dcr iowa head and. Since toti described the initial dacryocystorhinostomy dcr operation in 1904 many technical modifications have evolved becker in ophthalmic surg 19. The study aims to report a single trainees experience of learning and performing endoscopic endonasal dacryocystorhinostomy endcr. An endoscopic left anterior ethmoidectomy with marsupialisation of the mucocele was performed in combination with an endoscopic dcr. Endonasal surgery of the lacrimal sac is performed in the anterior aspect of the nasal fossa. Endonasal endoscopic and external dcr approaches have their own advantages and disadvantages. Fifty patients who underwent ext or enddcr between january 20102012. Tears secreted by lacrimal glands pass through laterally across ocular surface to lower canaliculi. It is superior to the external approach in revision.
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