Duration 5min, Q&A 3min
Mini Incision No Skin Suture External Dacryocystorhinostomy
To show the instruments and technique and report the results of mini incision no skin suture external dacryocystorhinostomy procedure (Ex-DCR).
This is a technique description and chart review of patients with nasolacrimal duct obstruction (NLDO) who had undergone a standard Ex-DCR through a 4 to 5 mm skin incision by one eye plastic surgeon (MBK). Inspiring from endoscopic endonasal DCR and ear procedures, some surgical instruments were changed to fit the aim of using mini incision for Ex-DCR.
A wider pre-periosteal dissection and sliding the wound in different directions allowed at least 3 times access (figures1-4) for bone nibbling. Functional success was defined as Munk 0 or 1 and anatomical success as free irrigation at last follows up visit. Air test (AT) was used by asking the subjects to hold the nostrils and blow the nose. Passage of air from nose to the eye was considered as positive AT. Subjects were asked to score their satisfaction of the site of incision regardless of the success of DCR using Visual Analogue Score (VAS) (0-100) at last follow up.
Results and Conclusion
There were 50 procedures (5 bilateral) in 45 patients (29 females) with a mean age of 52.3 years and follow up of 16.8 months. Primary (46), trauma (3), and medication (1) were the causes of NLDO. There were 8 reoperations. Procedures were performed either under general (30) or local (20) anesthesia. Associated common canalicular stenosis was found in 10, canalicular stenosis in 2, and both of them in 2 cases. Anatomical and functional success was 98% (49/50) and 94% (47/50), respectively. Air test was positive in 74% (37/50): 37 of 49 cases with anatomical success (75.5%) and 36 of 47 cases with functional success (76.5%). Etiology, Re-operation, age, and follow up time did not have a significant effect on the success rates. However, 2 (2/4; 50%) cases with canalicular stenosis had functional and 1 (1/4, 25%) anatomical failure (P<0.05). Mean VAS for the scar site was 98.8 (95-100). Failure did not significantly change the VAS.
Conclusion: Mini incision no skin suture Ex-DCR offers a high satisfaction and success (anatomical and functional). A gradual lessening of the standard incision would ease the learning curve.
[ Keyword ]
Dacryocystorhinostomy / Mini Incision / Sutureless
[ Conflict of Interest ]