Endoscopic Dacryocystorhinostomy; A New Technique
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Many types of EnDCR approaches have been tried, yet the long term success rates have not been equivalent to that achieved with ExDCR. In order to improve the surgical success of EnDCR, there has been increasing interest in modifring the way of handling lacrimal sac wall and nasal mucosa. Our prospective study on 31 patients (7 males and 24 females with age range of 19-52 years) complained of epiphora for at least 1 year were collected from March2000 to July 2003. They were diagnosed to have primary nasolacrimal duct obstruction with no previous lacrimal surgery. Surgery was performed by the first author . The follow up time was 6 months during which endoscopic evaluation of DCR and symptoms assessment were evaluated. The technique we describe encompasses important differences to previously described methods. It involves creation of a large rhinostomy and creation of a large posterior lacrimal sac flap and a small posterior nasal mucosal flap. This new technique promotes marsupialisation of the lacrimal sac onto the lateral nasal wall due to the close apposition of the large posterior lacrimal sac flap and small posterior nasal mucosal flap. Major complication was not found in any case. Success was defined as endoscopic patency of rhinostome with free flow of fluorescein and fluid during lacrimal syringing Our new technique described has a success rate of 87%(27/31) which compares favorably with ExDCR and also has a greater success rate than conventional endonasal DCR. Our techniqul does not require the acquisition of new surgical skills by surgeons or the usage of any sophisticated instruments. This new technique should be taken in considerable during EnDCR.