The current study aimed to compare the outcome of endonasal endoscopic (Endo)
dacniocvetorhinostomv (OCR) versus external (Ext) OCR with mitomucin C application.
Patients & Methods: 171£study included 18 patients; 5 males and 13females with mean age of 25.8 ± 12.8
years presented by epiphora secondary to lower lacrimal system obstruction with a mean duration of symptoms
was 3.2 ± 1.1 years. Patients were allocated into 2 groups: Endo-OCR group; underwent endoscopic transnascl
OCR and Ext-OCR+M underwent external OCR with application of mitomycin C. Patients were examined at
1-week, 1, 2, 4 and 6-months postoperative (PO). Postoperative success was evaluated by subjective resolution
of epiphora, negative regurge and positive irrigation tests. All patients underwent PO nasal endoscopy to assure
patency of the duct.
Results : Mean duration of surgery for E/ldo-OCR was significantly shorter compared to Ext-OCR.
Intraoperative difficulties included extensive manipulation for bony ostium formation during Endo-OCR in 4
patients. During Ext-OCR, intraoperative bleeding was troubleshooting in 3 cases, difficult bony ostium
[ormation in 2 patients and in one patient anteriorly displaced ethmoid was encountered. Posterior flap of the
nasal mucosa were lost in one case and both flaps were lost in another case. In Endo-D'Ck. grOllp, 2 patients
showed recurrent obstruction, on endoscopic examination a membranous scar at site of osteotomy; at 2- and at
A-months PO, endoscopic removal of granulation tissue and cauterization [ollouied by re-operation succeeded in
one patient but failed in the other The remaining 8 patients had complete resolution of symptoms with primarv
success rate of 80%, revision surgery rate of 20% and the total success rate was 90%. Another 2 patients in
Ext-OCR+M developed recurrent obstruction with positive regurge test and negative irrigation test with II
success rate of 75% after Ext-OCR+M that was non-significantly lower compared to Endo-OCR.
Conclusion: It could be concluded that endoscopic OCR provided superior outcome to external nCR WIth
good cosmetic appearance, short operative time and rapid patient recoven) and high success rate. However,
application of mitomvcin C is an adjuvant substance during external OCR increased its success rate and
external OCR with application of mitomycin C is advocated wherever endoscopic facilities were Jacking |
