A Faruk KIROĞLU, Köksal YÜCA, M Hafit GÜR, Y Kürdad VARSAK, Hakan ÇANKAYA, Adnan CINAL

The clinical results of endoscopic dacryocystorhinostomy

Epifora, gözyaşının lakrimal sistemdeki tıkanıklıktan dolayı nazal kaviteye geçememesi ile gelişen gözde yaşarma ile karakterize bir durumdur. Endoskopik dakriyosistorinostomi (EDSR)kronik dakriyosistit tedavisinde primer veya revizyon cerrahisi olarak uygu- lanabilen bir yöntemdir.Bu çalışmanın amacı EDSR operasyonunun sonuçlarını değerlendirmektir. Bu çalışmada EDSR operasyonu uygulanan 80 hastanın klinik sonuçları değerlendirilmiştir.12 kadına bilateral EDSR olmak üzere 82 bayan,10 erkek gözüne cer- rahi uygulandı. 72 hastaya bikanaliküler slikon tüp, 5 hastaya T tüp ve 15 hastaya sadece lakrimal kese nazal pasaj anastomozu yapıldı. Hastalar minimum 6 hafta, maksimum 36 hafta olmak üzere gözlemlendi.70 kadın,10 erkek olmak üzere 80 hastaya cer- rahi uygulandı. Ortalama yaş 38 idi. En sık şikayet epifora olup bütün hastalarda epifora mevcuttu. Operasyon %48.9 sağ tarafa uygulandı. Cerrahi uygulanan 92 gözden 8 (%8.7)inde lateral nazak duvar ve orta konka laeral nazal duvarı arasında sineşi, 16 (%17.4) hastada ostium etrafında granülasyon dokusu gelişti, hastaların 8ine (%8.7) revizyon EDSR uygulandı. Bunlardan 5 tanesi operasyondan fayda gördü. Slikon tüplerin ortalama kalış süresi ve standart sapması 4.64±1.271 (3 6)hafta olarak hesaplandı. Komplet ve parsiyel başarı oranları sırası ile 78.3 % ve 15.2 % olarak belirlendi. Sonuç olarak EDSR düşük komplikasyon insidansı, yüksek genel başarı oranı ile iyi tolere edilebilen alternatif bir operasyon tekniğidir. Ayrıca endoskopik cerrahi lakrimal pompa sistemini koruyan ve cerrahi skar bırakmayan bir yöntemdir.

Endoskopik dakriyosistorinostominin klinik sonuçları

Epiphora is a clinical case characterised with the liquefaction of the eyes as the tears can not reach to the nasal cavity because of an obstruction in the nasolacrimal system. Endoscopic dacryocystorhinostomy (EDCR) can be used primary or as a revision surgery to treat chronic dacryocystitis. The aim of this study is to evaluate the results of EDCR operation. In the study, clinical results of 80 patients after the EDCR operation have been evaluated. Bilaterally EDCR was applied to 12 of the female patients and 92 eyes were examined in total including 82 female patient eyes and 10 male patient eyes. Bicanalicular silicon tube was inserted to 72 of the patients and T tube was inserted to 5 of the patients,in 15 patients only anastomosis of the lacrimal sac to the nasal passage was performed. Patients were observed for minimum 6 and maximum 36 months. A total 80 patient underwent surgery. 70 of the patients were female and 10 of them were male. The average age was 38 years. The most common complaint epiphora detected in all patients. 48.9% of surgery was on rigt side. 8 (8.7%) of 92 eyes had synechia between the lateral nasal wall and the middle concha lateral surface and 16 (17.4%) of them had granulation tissues around the ostium. 8 (8.7%) eyes underwent the revision EDCR and 5 (5.4%) of them benefited. Average stay duration of the silicon tube and its standart deviation were cal- culated as 4.64±1.271 (3 6) months. Complete success rate and partial success rate was determined 78.3% and 15.2% respectively. In conclusion, EDCR is a well tolerated a valid alternative operation with low incidence of complications and has a high general success rate. Furthermore, endoscopic surgery may also have a benefit of preserving the lacrimal pump system and leaving no surgical scar.

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1. Linberg JV, Mc Cormick SA. Primary acquired nasolacrimal duct obsruction; a clinicopathologic report and biopsy technique. Ophthalmology 1986;93:1055-63.
2.MacEven CJ, Young JDH, Barras CW, Ram B, White PS. Value of nasal endoscopy and probing in the diagnosis and management of children with congenital epiphora. Br J Ophtalmol 2001;85;314-8.
3.Çinal A, Kutluhan A, Yaşar T, Şimşek Ş, Kırış M, İçli M. The comparison of the internal and external methods in the surgical treatment of chronic dacryocystitis. T Oft Gaz 1999;29:292-7.
4.Küpper DS, Demarco RC, Resende R, et al. Endoscopic nasal dacryocystorhinostomy:result and advantages over the ex- ternal approach. Braz J Otorhinolaryngol 2005;71:356-60
5.Knijnik D.Endonasal dacryocystrhinostomy in children. Braz J Otorhinolaryngol 2005;71:726-8.
6.Kuchar A, Lukas J, Steinkogler FJ. Bacteriology and an- tibiotic therapy in congenital nasolacrimal duct obstruc- tion. Acta Ophthalmol Scand 2000;78:694-8.
7.Whittet HB, Shun-shin GA, Awdry P. Functional endoscopic transnasal dacryocystorhinostomy. Eye 1993:7:545-9.
8.Kong YT, Kim TI, Byung WK. A report of 131 cases of endoscopic laser lacrimal surgery. Opthalmology 1994:101:1793-800.
9.Bartley GB. Acquired lacrimal drainage obstruction: an etiologic classification system, case reports and review of literature. Opthalmol Plast Reconstr Surg 1992:8:237-42.
10. Yung MW, Hardman_Lea S. Analysis of the results of surgi- cal endoscopic dacryocytorhinostomy: effect of the level of obstruction. Br J Ophthalmol 2002: 86: 792-4.
11. Akıner M, Anadolu Y, Aktürk T, Uğurlubaş SH, Zilelioğlu G. Endoscopic transnasal dacryocystorhinostomy. J Otolaryngol Head Neck Surg 1996;4:44-8.
12. Weıdnbecher M, Hosemann W, Buhr W; Endoscopic endo- nasal dacryocystorhinostomy; Results in 56 patients. Ann Otol Rhinol Laryngol 1994;103;363-7.
13. Önerci M, Orhan M. Endoscopic intranasal dacryocystorhi- nostomy. J Otolaryngol Head Neck Surg 1993;2(3):219-22.
14. Mclahlan DL, Shannon GM, Flanagan JC:Results of dac- ryocystorhinostomy Analysis of reoperations. Ophthalmic Surg 1980;11:427-30.
15. Benger R, Forer M. Endonasal dacryocystorhinos- tomy primary and secondary. Aust N Z J Ophthalmol 1993;21(3):157-9.
16. Rice DH. Endoscopic intranasal dacryocystorhinosto- my in four patients. Arch Otolaryngol Head Neck Surg 1990;116(9):1061.
17. Mcdonogh M. Endoscopic Transnasal Dacryocystorhinostomy. Endoscopic transnasal dacryo- cystorhinostomy. Results in 21 patients. S Afr J Surg 1992;30(3):107-10.
18. Önerci M, Orhan M, Öğretmenoğlu O, İrkeç M. Long- term results and reasons for failure of intranasal Endoscopic dacryocystorhinostomy. Acta Otolaryngol 2000;120(2):319-22.
19. Sodhi PK, Pandey RM, Malik KPS. Experience with bicana- licular intubation of the lacrimal drainage apparatus combined with conventional external dacryocystorhinos- tomy. J Craniomaxillofac Surg 2003;31:187-90
20. Argın A, Duman S, Örnek F. The role of the silicon intu- bation in dacryocystorhinostomy (Turkish). J Mersin Univ Med Faculty 2001;3:281-4
21. Metson R. The Endoscopic Approach for Revision Dacryocystorhinostomy. Laryngoscope1990;100:1344-7.
22. Watkins LM, Janfaza P, Rubin PA. The evolution of endo- nasal dacryocystorhinostomy. Surg Ophthalmol 2003;48: 73-84.
23. Ünlü HH, Toprak B, Aslan A, Güler C. Comparison of surgi- cal outcomes in primary endoscopic dacryocystorhinosto- my with and without silicone intubation. Ann Otol Rhinol Laryngol 2002;111: 704-9.
24. Şan İ, Gürler B. Endoscopic dacryocystorhinostomy: Operative problems in the initial cases. Turk Arch Otolaryngol 2002;40:258-63
25. Munk PL, Lin DT, Morris DC. Epiphora: treatment by means of dacryocystorhinostomy with balloon dilation of the nasolacrimal drainage apparatus. Radiology 1990; 177(13):687-90.
26. Luchtenberg M, Kuhli C, du Mesnil de Rochemont R, Yan B, Ohrloff C, Berkefeld J. Three-dimensional rota- tional dacryocystography for imaging of the lacrimal draining system and adjacent anatomical structures. Ophthalmologica 2005;219(3):136-41.
27. Yoshii M. External Dacryocystorhinostomy: outcomes af- ter the introduction of two new forceps and transnasal endoscopy. Med Sci Monit 2004;10(3):39-42.
28. Yazici B, Yazici Z. Final nasolacrimal ostium after ex- ternal dacryocystorhinostomy. Arch Ophthalmol 2003; 121(1):76-80.
29. Boboridis KG, Bunce C, Rose GE. Outcome of external dac- ryocystorhinostomy combined with membranectomy of a distal canalicular obstruction. Am J Ophthalmol 2005; 139(6):1051-5.
30. Kashkouli MB, Parvaresh M, Modarreszadeh M, Hashemi M, Beigi B. Factors affecting the success of external dac- ryocystorhinostomy. Orbit 2003; 22(4):247-55.
31. Groessl SA, Sires BS, Bradley N. An anatomical basis for primary acquired nasolacrimal duct obstruction. Arch Ophthalmol 1997;115:71-4
32. Örnek F, Duman S, Kasım A. The causes of the lacrimal drainage system obstructions that can not be monitorized with a contrast agent and the surgical approach. T Klin Ophtalmology 1996;5(3):206-8.
33. Cuthbertson FM, Webber S. Assessment of functional na- solacrimal duct obstruction survey of ophthalmologists in the southwest. Eye 2004;18(1):20-3.
34. Becker BB. Dacryocystorhinostomy without flaps. Ophthalmic Surg 1988;19(6):419-27.
35. Boush GA, Bradley NL. Dortzbach RK. Results of endona- sal laser-assisted dacryocystorhinostomy. Opthalmology 1994:101:955-59 .
36. Wearne M, Pitts J, Frank J, and Rose G. Comparison of dacryocystography and lacrimal scintigraphy in the di- agnosis of functional nasolacrimal duct obstruction. Br J Ophthalmol 1999;83(9):10325.
37. Çokkeser Y, Evreklioğlu C, Er H. Comparative exter- nal versus endoscopic dacryocytorhinostomy: Results in 115 patients (130 eyes). Otolaryngol Head Neck Surg 2000:123(4): 488-91.