Endoscopic versus external approach dacryocystorhinostomy. All patients were operated on by same team of surgeons. Focusing on the endonasal approach, we compared success rates, clinical outcome, complications and patient satisfaction of endoscopic vs. This included three patients with postoperative hemorrhage two who had endonasal dcr surgery and one having external dcr surgery. Those corrections result not only in relief of residual tension around the skull but changes in the entire body. Tears generated by the tear glands in your eyes need to be drained to the nose. Dcr, or dacryocystorhynostomy, is a surgery performed to create a new tear drain between the eye and nose when your current tear drain becomes blocked or obstructed. Bicanalicular silicone stents in endonasal dcr american. Abc endonasal cranial correction ecc is a proven and effective method that helps bring the body back into alignment through the correction of cranial bones out of place in a direction the body cannot selfcorrect. Also, these patients tend to be of an older age group that are not conscious of a small scar by the side of the eye. The endonasal dcr technique uses a fberoptic probe inserted in the punctum for guidance.
This can be accessed though control panel administrative tools services. This study evaluates the preservation of lacrimal pump function in both procedures. Dcr is listed in the worlds largest and most authoritative dictionary database of abbreviations and acronyms the free dictionary. Endolacrimal ktp laserassisted dacryocystorhinostomy. Long term success of endodcr with silicone tube catheter. Comparison of endoscopic and external dacryocystorhinostomy for.
From there, the tears travel through little tubelike structures canaliculi to the lacrimal sac. Laser transcanalicular endonasal dcr is also becoming popular due to its inherent advantages over endonasal laser delivery systems such as the laser direction being away from the globe and the approach being more familiar to the ophthalmic surgeon. Endoscopic vs external dacryocystorhinostomycomparison. These prerequisites encompass appropriate technical equipment. This video demonstrates endoscopic dcr performed on a 57yearold female. Mechanical endonasal dacryocystorhinostomy with mucosal flaps. To compare success rates of external dacryocystorhinostomy dcr and endoscopic endonasal dcr for acquired. Be sure that the net service is located in services. Using an endoscope, the dcr can be performed by endonasal route using either laser 4,5 or surgical instruments 6,7 or both. Pdf clinical outcome of endonasal ktp laser assisted. Published success rates for external dcr, endonasal dcr and endocanalicular laser dcr range widely from 50% to 99%. Dacrocystorhinostomy dcr is an operation used to treat nasolacrimal duct obstruction.
External and endonasal dacryocystorhinostomy exdcr and endcr, respectively affect the tear drainage mechanism. They found a higher rate of success in the stent surgeries. Article in classic viewepub betaprinter friendlycitation. It allows capturing images with an extremely high resolution and a 75. Tsirbas and wormald are to be congratulated on their landmark paper in lacrimal surgery describing endonasal dacryocystorhinostomy dcr with mucosal flaps, 1 which is also known as powered endonasal dcr. Dacryocystectomy definition of dacryocystectomy by. The study involved prospective interventional case series with short perioperative follow up. We analyzed the results of 173 patients who underwent an. Definition dacryocystitis is an inflammation of the tear sac lacrimal sac at the inner corner of the eye. Fifty patients who underwent ext or enddcr between january 20102012 were involved in the study.
Instructions following endonasal dcr surgery other medications pg2 eye drops, if prescribed, are instilled into the eye 3 times a day. Primary acquired nasolacrimal duct obstruction is the commonest cause of chronic dacryocystitis presenting with symptoms like epiphora, discharge, irritation and pain. All instruments are handcrafted using the finest german quality stainless steel. Endoscopic dacryocystorhinostomy oculoplastic eyelid. External in short, both techniques are highly successful. A questionnaire was applied to patients preoperatively, and. This article tries to provide few tips to make dcr easy and stressfree.
External versus endonasal dacryocystorhinostomy in a. The light from the probe is visualized in the nose through a rigid nasa. Endoscopic endonasal dcr plays an established role in revision dcr surgery. Dacryocystitis definition of dacryocystitis by medical. For bone removal, kerrisons punch and dcr burr was used. Dear reader, enhancing the visualization of medical professionals is a core focal point for us at the medical technology business of zeiss. Paediatric endonasal endoscopic dcr seems to be an effective, safe and minimally invasive technique for the treat ment of mechanical nasolacrimal system obstruction. During recent years endonasal dcr was developed as an alternative surgical technique.
In recent years, threedimensional 3d printing has been mentioned throughout the media as a huge opportunity for industrial manufacturing and. This study was done to assess the efficacy of powered endoscopic dacryocystorhinostomy dcr with creation of a large bony ostium exposing fundus of the sac and primary mucosal anastomosis. Pooled results showed that both surgical approaches had similar success rates endoscopic endonasal dcr 82. Endonasal endoscopic dcr with full sac exposure is now considered the. Endonasal cranial correction advanced biostructural. Endonasal dcr can be performed with the help of rigid endoscopes or under binocular operating microscopes. Looking for online definition of dcr or what dcr stands for. To study the outcome of endonasal endoscopic dacryocystorhinostomy dcr with or without mucosal flap preservation, without mitomycin local application, silicon tube. In good hands however, the scar is very inconspicuous.
Several ophthalmologists fear performing dcr because of bleeding and unfamiliarity of structure. The basic indication is same in all cases and either route can be used. Females have significantly smaller dimensions in the lower nasolacrimal fossa and middle nasolacrimal duct. The files of 165 patients who underwent endonasal dcr at a tertiary referral centre between 1991 and 2001 were retrospectively assessed. Recently, advanced approaches utilizing tissue damage, the preservation.
The light from the probe is visualized in the nose through a rigid nasal scope. Laser dcr laser dacryocystorhynostomycreating a new tear drain. Citrix fahig, unterstutzt pdf hintergrunde, wasserzeichen, als pdf netzwerk drucker. His dacryocystorhinostomy through an endonasal approach evaded popularity. The study involved a prospective nonrandomised interventional case series with short perioperative follow up. Compared with external dcr, endoscopic dcr is more.
Mri evaluation of lacrimal drainage after external and. His group also found the nasal approach more rapid and more acceptable to patients. The plugin will add command line options to nosetests. Endonasal dcr should not be done when malignant tumour is in proximity of nldit is may be cause of obstruction. Jedmed has a full line of instrumentation for the endonasal dcr procedure. Dacryocystorhinostomy dcr is performed in patients with saccal or postsaccal lacrimal duct obstruction. External dacryocystorhinostomy dcr is the most common and wellknown surgical method to restore the nasolacrimal system. Using self retaining speculum one can work bimanually. This requires removal of the small amount of bone that lies between your tear sac and your nose. Cases of successful endcr 4 patients and exdcr 4 patients were included. Early results with the endoscopic dcr were not as good as the best results. The main argument for an endonasal approach is the lack of a scar. You may also be prescribed antibiotic tablets or capsules.
There is excellent illumination and magnification 2. Conventional dacryocystorhinostomy versus endonasal. An assessment of those significant reports about dcr techniques. Ct scanningsometimes called cat scanningis a noninvasive, painless medical test that helps physicians diagnose and treat medical conditions. Pdf endonasal dacryocystorhinostomy dcr without flap and. Operative and postoperative data were prospectively. Endoscopic dacryocystorhinostomy dcr has been the preferred treatment in the management of epiphora and many techniques were described by different. Longterm results of endonasal dacryocystorhinostomy. We strive to help our users across a broad range of medical disciplines see more. In the case of cicatricial obstruction at the osteotomy site, it is easier to perform endoscopic revision, and the patient is more likely to accept such a revision without visible external cuts. It can be done with external ex or endonasal en access. Digital journal of ophthalmology 2015 volume 21, number 3 september 20, 2015 doi. This approach allows the surgeon to deal with nasal adhesions, granulomatous tissue and hypertrophic turbinates at the same time. The success rates for endonasal dacryocystorhinostomy.
The spiway is designed to help reduce mucosal trauma and keep the scope clean. Packaged in singleuse centrix syringe tips, accessflo saves time while eliminating crosscontamination. The introduction of endonasal laser dacryocystorhinostomy enldcr in the early 1990s showed great promise of changing dacryocystorhinostomy. The endonasal dcr technique uses a fiberoptic probe inserted in the punctum for guidance. Dcr involves opening up your existing tear sac and connecting it directly into the nose to form a new tear drainage pathway. Disadvantages of endonasal dcr include the preferred use of general anesthesia by many surgeons, the high cost of expensive equipment and instrumentation, and the relatively steep learning curve for this procedure. External dacryocystorhinostomy dcr is the mainstay of treatment for this problem with a reasonable. This potentially leads to cleaner surgical fields and improved surgical efficiency. To compare the success and complication rates, duration of surgeries and clinical comfort after endoscopic dacryocystorhinostomy enddcr or external dacryocystorhinostomy extdcr. Benign growths, sinonasal polyposis, septal deviations, allergic rhinitis, atrophic rhinitis, are all patients fit to be taken up for surgery, but since the pathology could be causative factor should be eliminated beforesimultaneously or after the.
Endonasal dcr is far superior than external dcr reason is simple and obvious. This is a new technique that involves creation of a large rhinostomy and mucosal flaps. Endonasal dcr was first completed in 1958 with the use of a microscope, and later the procedure used endoscope systems and lasers. Complication rates were low in both types of surgery. Description tears drain into little openings puncta in the inner corners of the eyelids. Both kerrison punch and drill are widely used in endoscopic dcr with. Our experience endonasal dacryocystorhinostomy is considered to be the standard treatment for chronic dacryocystitis, and is simple to perform and is very effective even in patients. Depending on the preference of the surgeon, more postoperative care may be required for patients undergoing endonasal dcr than. Current and future possibilities with printed model teeth. Most of patients are females so if in any way a scar can be prevented over face will be a better option 4. Endoscopic endonasal dacryocystorhinostomy dcr is the best, scar free no scar, lacrimal surgery performed for restoration of tears flow into the nose from the lacrimal sac, when the nasolacrimal duct tear duct has become blocked blocked tear duct tear duct obstruction. Ct eartemporal bonepetrous ridges mercy medical center. Appropriate frame conditions provided, the respective procedures are safe and successful.
All planmeca cbct imaging units offer an imaging mode tailored for endodontics. Twenty two patients were followed up in groupi and thirtysix patients were followed up in groupii. Despite ease and decreased morbidity of endonasal dcr, external dcr is procedure of choice as it is more successful. Despite much debate, many still believe that external dcr provides a high success rates than endoscopic dcr though many types of endonasal approaches have been attempted, long term success rates are less than ext.
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