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Non-endoscopic Mechanical Endonasal Dacryocystorhinostomy.

Razavi ME, Noorollahian M, Eslampoor A - J Ophthalmic Vis Res (2011)

Bottom Line: The lacrimal sac is tented into the surgical site with the light probe and its medial wall is incised using a 3.2 mm keratome and then excised using the Blakesley forceps.The procedure is completed by silicone intubation.The NE-MEDCR technique does not require expensive instrumentation and is feasible in any standard ophthalmic surgical setting.

View Article: PubMed Central - PubMed

Affiliation: Khatam-al-Anbia Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

ABSTRACT
To circumvent the disadvantages of endoscopic dacryocystorhinostomy such as small rhinostomy size, high failure rate and expensive equipment, we hereby introduce a modified technique of non-endoscopic mechanical endonasal dacryocystorhinostomy (NE-MEDCR). Surgery is performed under general anesthesia with local decongestion of the nasal mucosa. A 20-gauge vitrectomy light probe is introduced through the upper canaliculus until it touches the bony medial wall of the lacrimal sac. While directly viewing the transilluminated target area, a nasal speculum with a fiber optic light carrier is inserted. An incision is made vertically or in a curvilinear fashion on the nasal mucosa in the lacrimal sac down to the bone using a Freer periosteum elevator. Approximately 1 to 1.5 cm of nasal mucosa is removed with Blakesley forceps. Using a lacrimal punch, the thick bone of the frontal process of the maxilla is removed and the inferior half of the sac is uncovered. The lacrimal sac is tented into the surgical site with the light probe and its medial wall is incised using a 3.2 mm keratome and then excised using the Blakesley forceps. The procedure is completed by silicone intubation. The NE-MEDCR technique does not require expensive instrumentation and is feasible in any standard ophthalmic surgical setting.

No MeSH data available.


Lacrimal sac incision (A & B) and lacrimal sac flap removal (C & D).
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f8-jovr-6-3-219: Lacrimal sac incision (A & B) and lacrimal sac flap removal (C & D).

Mentions: Approximately 1 to 1.5 cm of nasal mucosa is removed using Blakesley or Takahashi forceps (Storz endoscope instruments, Karl Storz, Germany). Once the lacrimal fossa is exposed, the thin lacrimal bone is elevated from the posterior half of the lower lacrimal sac up to the insertion of the uncinate process (Figures 5 and 6). Using a forward-biting lacrimal punch, the hard thick bone of the frontal process of the maxilla is then removed and the inferior half of the sac is uncovered (Fig. 7). Once the lacrimal sac mucosa is exposed, the lacrimal sac is tented into the surgical site using the light probe followed by incision of the medial wall of the lacrimal sac using a 3.2 mm keratome and than excision with a Blakesley forceps (Figures 8 and 9).


Non-endoscopic Mechanical Endonasal Dacryocystorhinostomy.

Razavi ME, Noorollahian M, Eslampoor A - J Ophthalmic Vis Res (2011)

Lacrimal sac incision (A & B) and lacrimal sac flap removal (C & D).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3306095&req=5

f8-jovr-6-3-219: Lacrimal sac incision (A & B) and lacrimal sac flap removal (C & D).
Mentions: Approximately 1 to 1.5 cm of nasal mucosa is removed using Blakesley or Takahashi forceps (Storz endoscope instruments, Karl Storz, Germany). Once the lacrimal fossa is exposed, the thin lacrimal bone is elevated from the posterior half of the lower lacrimal sac up to the insertion of the uncinate process (Figures 5 and 6). Using a forward-biting lacrimal punch, the hard thick bone of the frontal process of the maxilla is then removed and the inferior half of the sac is uncovered (Fig. 7). Once the lacrimal sac mucosa is exposed, the lacrimal sac is tented into the surgical site using the light probe followed by incision of the medial wall of the lacrimal sac using a 3.2 mm keratome and than excision with a Blakesley forceps (Figures 8 and 9).

Bottom Line: The lacrimal sac is tented into the surgical site with the light probe and its medial wall is incised using a 3.2 mm keratome and then excised using the Blakesley forceps.The procedure is completed by silicone intubation.The NE-MEDCR technique does not require expensive instrumentation and is feasible in any standard ophthalmic surgical setting.

View Article: PubMed Central - PubMed

Affiliation: Khatam-al-Anbia Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

ABSTRACT
To circumvent the disadvantages of endoscopic dacryocystorhinostomy such as small rhinostomy size, high failure rate and expensive equipment, we hereby introduce a modified technique of non-endoscopic mechanical endonasal dacryocystorhinostomy (NE-MEDCR). Surgery is performed under general anesthesia with local decongestion of the nasal mucosa. A 20-gauge vitrectomy light probe is introduced through the upper canaliculus until it touches the bony medial wall of the lacrimal sac. While directly viewing the transilluminated target area, a nasal speculum with a fiber optic light carrier is inserted. An incision is made vertically or in a curvilinear fashion on the nasal mucosa in the lacrimal sac down to the bone using a Freer periosteum elevator. Approximately 1 to 1.5 cm of nasal mucosa is removed with Blakesley forceps. Using a lacrimal punch, the thick bone of the frontal process of the maxilla is removed and the inferior half of the sac is uncovered. The lacrimal sac is tented into the surgical site with the light probe and its medial wall is incised using a 3.2 mm keratome and then excised using the Blakesley forceps. The procedure is completed by silicone intubation. The NE-MEDCR technique does not require expensive instrumentation and is feasible in any standard ophthalmic surgical setting.

No MeSH data available.