IMPROVED SURGICAL OUTCOME OF ENDONASAL DCR WITH PRESERVATION OF NASAL MUCOSAL FLAPS
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 14
Abstract
BACKGROUND Dacryocystorhinostomy (DCR) has distinct advantage over external DCR. It is a highly evolving endoscopic procedure of management of dacryocystitis. It is a surgery in which a fistulous tract is created between the lacrimal sac and nasal cavity when epiphora does not respond to medications and repeated syringing of nasolacrimal duct. The advantages of endonasal DCR over external DCR are- there is no ugly scar on the face, less intraoperative bleeding, day care procedure, simple and less time consuming procedure and safe but skilful surgery. The long-term success rate of external DCR in dedicated oculoplastic census is very high (90% - 95%). But although the better success rate is seen, which is close to 100% with some modifications in endonasal DCR techniques. Even if there is recurrence of epiphora, it is again correctable fully with no residual effects. Aim and Objective- To compare outcome of new method of endonasal DCR. MATERIALS AND METHODS A non-randomised controlled trial was conducted from February 2014 to March 2017. A sample size of 360 was taken for convenience in 360 patients, of which 108 (30%) were males and 252 (70%) were females. We performed few cases with removal of nasal mucosal flap and rest of the cases with preservation of nasal mucosal flaps. RESULTS 360 patients were operated for chronic dacryocystitis. 200 patients were operated with modified technique of preserving nasal mucosal flap and repositioning it at the end of surgery with the intention of no bare bone should be left behind named as Group A. 160 patients were operated with routine method where nasal mucosa was removed named as Group B. No intraoperative complications were encountered. Average follow-up duration was 24 months. During this period, the elimination of subjective symptoms and patency of the nasolacrimal passage confirmed by saline irrigations and endoscopic visualisation of ostium were accepted as surgical success. Surgical success was achieved in 197 (98.5%) out of the 200 patients in group A. In group B, success was achieved in 147 (91.8%) out of 160. Our study shows increase in success rate when technique is modified with repositioning of nasal mucosal flap on bare bone, which reduces chances of synechiae and granulation postoperatively. CONCLUSION Comparative study of these two methods showed that there is marked improvement in surgical outcome of endonasal DCR when the nasal mucosal flap is preserved.
Authors and Affiliations
Anagha Rajguru, Yogesh Rajguru, Nikhil Vala, Ashish Kadam
Keywords
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- EP ID EP414364
- DOI 10.14260/jemds/2018/398
- Views 91
- Downloads 0
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