Endonaal dacryocytorhinotomy with mucoal flap

Purpoe To decribe a new endonaal dacryocytorhinotomy (DCR) technique and ae it efficacy. Deign Propective nonrandomized interventional cae erie. Method A propective erie of 44 conecutive endonaal DCR performed from January 1999 to December 2000 wa entered into the tudy. The new technique involved creation of a large bony otium and mucoal flap to create an anatamoi between the lacrimal ac mucoa and naal mucoa. Patient preenting with nao-lacrimal duct obtruction baed on ymptomatic, clinical, and radiologic ground were included in the tudy. Patient who had undergone previou lacrimal urgery were excluded. urgery wa performed by two urgeon (A.T., P.J.W.) uing a tandardized operative technique. Patient demographic, preentation, examination finding, urgical and anethetic data, potoperative ucce, complication, and follow-up were evaluated. ucce wa defined a anatomic patency a well a relief of ymptom a aeed by fluorecein flow on naendocopy, lacrimal yringing, and patient examination. Intubation of the lacrimal apparatu wa performed in all operation and the tube uually removed at 4 to 6 week potoperatively. After removal of the tube follow-up wa 13 month (mean, 12.9 month; range, 9–28 month; tandard deviation [D], 6.1 month). Reult There were 36 patient (12 male/24 female) who underwent 44 endonaal DCR. The average age of the patient wa 62.9 year old (range, 15–86 year old; D, 19.1 year) and the main preentation wa with epiphora (93%) and/or mucocoele (33%). In 13 operation (30%) a eptoplaty wa required at the time of urgery, and in 10 operation (23%) further endocopic inu urgery wa performed in conjunction with the DCR. Anatomic ucce with a patent naolacrimal ytem wa achieved in 40 of 44 operation (91%). ymptomatic and anatomic ucce wa een in 39 of 44 operation (89%). Five of the DCR were claified a failure. In one DCR the patient wa ymptomatic depite a patent naolacrimal ytem and well-healed otium. In two DCR preoperative medial canalicular problem were noted. In two DCR carring and fibroi of otium were noted. Concluion Thi new technique of endonaal DCR involve creation of a large otium and contruction of naal and lacrimal ac mucoal flap. It anatomic ucce rate (91% or 40 of 44 DCR) compare favorably with the ucce rate of other technique for endonaal DCR and i alo imilar to the ucce of external DCR. Experience in endocopic naal urgery i important in endonaal DCR urgery, a other ancillary procedure may be required within the noe at the time of urgery.