Mehmet Balbaba, Tuba Bayindir, Mahmut Tayyar Kalcioglu, Erkan Karatas, Yuksel Toplu, Emrah Sapmaz

Nasolacrimal duct obstruction with obstructive nasal deformity; is synchronous nasal surgery necessary?

The aim of this study was to evaluate the necessity of the simultaneous additional nasal surgery to increase success rate of the endoscopic dacryocystorhinostomy operation, in the patients with nasolacrimal duct obstruction and obstructive nasal deformity. One hundred and thirty patients with nasolacrimal duct obstruction and obstructive nasal deformity (59 were female and 71 male, age ranged between 31 and 82 years, mean=60.3 years) were included in this study. Patients with nasolacrimal duct obstruction were divided into two main groups (group A and B) and six subgroups (A1, A2, A3 and B1, B2, B3) according to the presence of obstructive nasal deformity and applied operation techniques. The success and complications rates of this groups were evaluated. The success rates of endoscopic dacryocystorhinostomy in the additional nasal surgery performed group (Group A) were not statistically significant higher than the group without additional nasal surgery (Group B). Complications rate of group A (26.08%) were statistically significant higher than group B (9.8%). In patients with complications, the average success rate of endoscopic dacryocystorhinostomy surgery (70.8%) was statistically significant lower than in patients with no complications (88.6%), respectively. Additional nasal surgery has no statistically significant effect on the success of the endoscopic dacryocystorhinostomy surgery. Developing complications was statistically affect the success rate of endoscopic dacryocystorhinostomy surgery. Due to these reasons, contrary to the general idea, we believe that, to increase the success rate of the endoscopic dacryocystorhinostomy surgery, additional nasal surgery is unnecessary in patients with nasolacrimal duct obstruction and obstructive nasal deformity.

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1. Watkins LM, Janfaza P, Rubin PAD. The evolution of endonasal dacryocystorhinostomy. Surv Ophthalmol. 2003;48:73–84.
2. Toti A. Nuovo metodo conservatore dicura radicale delle suppurazione croniche del sacco lacrimale (dacricistorhinostomia). Clin Mod. 1904;10:385-9.
3. McDonough M, Meiring JH. Endoscopic transnasal dacryocystorhinostomy. J Laryngol Otol. 1989;103:585-7.
4. Sonkhya N, Mishra P. Endoscopic transnasal dacryocystorhinostomy with nasal mucosal and posterior lacrimal sac flap. J Laryngol Otol. 2009;123:320-6.
5. Kim C, Kacker A, Levine B, et al. Lacrimal system endoscopy assisted endonasal dacryocystorhinostomy. Orbit. 2013;32:156-60.
6. Coumou AD, Genders SW, Smid TM, et al. Endoscopic dacryocystorhinostomy: Long-term experience and outcomes. Acta Ophthalmol. 2017;95:74-8.
7. Kumar S, Mishra AK, Sethi A, et al. Comparing outcomes of the standard technique of endoscopic DCR with its modifications: A retrospective analysis. Otolaryngol Head Neck Surg. 2018;194599818813123
8. Zandi A, Nadafi F. Effects of local Mitomycine-C on the out come of dacriocystorhinostomy in the patients with nasolacrimal duct obstruction. Res Med Sci. 2006;1:41-4.
9. Figueira E, Abbadi ZA, Malhotra R, et al. Frequency of simultaneous nasal procedures in endoscopic dacryocystorhinostomy. Ophthal Plast Reconstr Surg. 2014;30:40-3.
10. Ali MJ, Psaltis AJ, Wormald PJ. The frequency of concomitant adjunctive nasal procedures in powered endoscopic dacryocystorhinostomy. Orbit. 2015;34:142-5.
11. Habesoglu M, Eriman M, Habesoglu TE, et al. Co-occurrence and possible role of sinonasal anomalies in primary acquired nasolacrimal duct obstruction. J Craniofac Surg. 2013;24:497-500.
12. Chan DM, Golubev I, Shipchandler TZ, et al. Improving outcomes by combining septoplasty with primary external dacryocystorhinostomy. Am J Otolaryngol. 2014;35:309–312.
13. Grymer LF, Pallisgaard C, Melsen B. The nasal septum in relation to the development of the nasomaxillary complex: A study in identical twins. Laryngoscope. 1991;101: 863-8.
14. Bayraktar C, Simsek A. Increased concomitant nasal procedure frequency in bilateral endoscopic dacryocystorhinostomy. J Craniofac Surg. 2017;28:980-2.
15. Kalman JE, Foster JA, Wulc AE. Computed tomography in lacrimal outflow obstruction. Ophthalmology. 1997;104:676-82.
16. Dantas RR. Lacrimal drainage system obstruction. Semin Ophthalmol 2010;25:98–103.
17. Kashkouli MB, Sadeghipour A, Kaghazkanani R, et al. Pathogenesis of primary acquired nasolacrimal duct obstruction. Orbit 2010;29:11–5.
18. Linberg JV, McCormick SA. Primary acquired nasolacrimal duct obstruction. A clinicopathologic report and biopsy technique. Ophthalmology. 1986;93:1055-63.
19. Mc Cormick A, Sloan B. The diameter of the nasolacrimal canal measured by computed tomography: gender and racial differences. Clin Exper Ophthalmol. 2009;37:357-61.
20. Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope. 1991;101:56-64.
21. Nussbaumer M, Schreiber S, Yung MW. Concomitant nasal procedures in endoscopic dacryocystorhinostomy. J Laryngol Otol. 2004;118:267-9.
22. Calhoun KH, Waggenspack GA, Simpson CB, et al. CT evaluation of the paranasal sinuses in symptomatic and asymptomatic populations. Otolaryngol Head Neck Surg. 1991;104:480-3.
23. Cannon CR. Endoscopic management of concha bullosa. Otolaryngol Head Neck Surg. 1994;110:449-54.
24. Unlu HH, Akyar S, Caylan R, et al. Concha bullosa. J Otolaryngol. 1994;23:23-7.
25. Aktas D, Kalcioglu MT, Kutlu R, et al. The relationship between the concha bullosa, nasal septal deviation and sinusitis. Rhinology. 2003;41:103-6.
26. Eyigor H, Unsal AI, Unsal A. The role of accompanying sinonasal abnormalities in the outcome of endonasal dacryocystorhinostomy. Am J Rhinol. 2006;20:620-4.