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Endoscopic dacryocystorhinostomy as treatment for lower lacrimal pathway obstructions in adults: Review article.

Penttilä E, Smirnov G, Tuomilehto H, Kaarniranta K, Seppä J - Allergy Rhinol (Providence) (2015)

Bottom Line: Conservative treatments only achieve temporary relief of symptoms, thus surgery is the treatment of choice.The aim of this operation is to create a bypass between the lacrimal sac and the nasal cavity.This article reviews the published literature about the technical issues associated with the success of EN-DCR, and clarifies the pros and cons of different pre- and postoperative procedures in adults with lower lacrimal pathway obstructions.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, and University of Eastern Finland, and Kuopio University Hospital, Finland.

ABSTRACT
Obstruction of the lacrimal pathway is manifested by epiphora, infection, and blurred vision as well as ocular and facial pain. Conservative treatments only achieve temporary relief of symptoms, thus surgery is the treatment of choice. Dacryocystorhinostomy (DCR) is recognized as the most suitable treatment for patients with obstructions of the lacrimal system at the level of the sac or in the nasolacrimal duct. The aim of this operation is to create a bypass between the lacrimal sac and the nasal cavity. During the past 2 decades, advances in rigid endoscopic equipment and other instruments have made it possible to obtain more information about the anatomic landmarks of the nasolacrimal system, which led to the development of less-invasive and safer endoscopic techniques. However, many parts of the treatment process related to endoscopic endonasal dacryocystorhinostomy (EN-DCR) still remain controversial. This article reviews the published literature about the technical issues associated with the success of EN-DCR, and clarifies the pros and cons of different pre- and postoperative procedures in adults with lower lacrimal pathway obstructions.

No MeSH data available.


Related in: MedlinePlus

Localization of the lacrimal sac: 1, roof of the lacrimal sac; 2, axilla of the middle turbinate; 3, superior turbinate; 4, nasolacrimal duct; 5, uncinate process; 6, middle turbinate; 7, inferior turbinate
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Figure 3: Localization of the lacrimal sac: 1, roof of the lacrimal sac; 2, axilla of the middle turbinate; 3, superior turbinate; 4, nasolacrimal duct; 5, uncinate process; 6, middle turbinate; 7, inferior turbinate

Mentions: Should the anatomic landmarks of the lateral nasal wall have been altered or do not exist, it may be very difficult to pinpoint the lacrimal sac.22 Christensen23 introduced the idea of transillumination to help in visualizing the location of the lacrimal sac in DCR by using an endoilluminator probe introduced through the canaliculis into the lacrimal sac. Today, endoillumination is a widely used method for locating the lacrimal sac with different endoscopic techniques.24,25 Many investigators claim that the axilla of the middle turbinate is a landmark for the roof of the lacrimal sac.22,26 However, Wormald et al.,27 in an anatomic study with 47 patients, showed that the major part of the lacrimal sac (10 mm) is situated above the axilla of the middle turbinate and that it extends 1–2 mm below this landmark (Fig. 3).


Endoscopic dacryocystorhinostomy as treatment for lower lacrimal pathway obstructions in adults: Review article.

Penttilä E, Smirnov G, Tuomilehto H, Kaarniranta K, Seppä J - Allergy Rhinol (Providence) (2015)

Localization of the lacrimal sac: 1, roof of the lacrimal sac; 2, axilla of the middle turbinate; 3, superior turbinate; 4, nasolacrimal duct; 5, uncinate process; 6, middle turbinate; 7, inferior turbinate
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4388871&req=5

Figure 3: Localization of the lacrimal sac: 1, roof of the lacrimal sac; 2, axilla of the middle turbinate; 3, superior turbinate; 4, nasolacrimal duct; 5, uncinate process; 6, middle turbinate; 7, inferior turbinate
Mentions: Should the anatomic landmarks of the lateral nasal wall have been altered or do not exist, it may be very difficult to pinpoint the lacrimal sac.22 Christensen23 introduced the idea of transillumination to help in visualizing the location of the lacrimal sac in DCR by using an endoilluminator probe introduced through the canaliculis into the lacrimal sac. Today, endoillumination is a widely used method for locating the lacrimal sac with different endoscopic techniques.24,25 Many investigators claim that the axilla of the middle turbinate is a landmark for the roof of the lacrimal sac.22,26 However, Wormald et al.,27 in an anatomic study with 47 patients, showed that the major part of the lacrimal sac (10 mm) is situated above the axilla of the middle turbinate and that it extends 1–2 mm below this landmark (Fig. 3).

Bottom Line: Conservative treatments only achieve temporary relief of symptoms, thus surgery is the treatment of choice.The aim of this operation is to create a bypass between the lacrimal sac and the nasal cavity.This article reviews the published literature about the technical issues associated with the success of EN-DCR, and clarifies the pros and cons of different pre- and postoperative procedures in adults with lower lacrimal pathway obstructions.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, and University of Eastern Finland, and Kuopio University Hospital, Finland.

ABSTRACT
Obstruction of the lacrimal pathway is manifested by epiphora, infection, and blurred vision as well as ocular and facial pain. Conservative treatments only achieve temporary relief of symptoms, thus surgery is the treatment of choice. Dacryocystorhinostomy (DCR) is recognized as the most suitable treatment for patients with obstructions of the lacrimal system at the level of the sac or in the nasolacrimal duct. The aim of this operation is to create a bypass between the lacrimal sac and the nasal cavity. During the past 2 decades, advances in rigid endoscopic equipment and other instruments have made it possible to obtain more information about the anatomic landmarks of the nasolacrimal system, which led to the development of less-invasive and safer endoscopic techniques. However, many parts of the treatment process related to endoscopic endonasal dacryocystorhinostomy (EN-DCR) still remain controversial. This article reviews the published literature about the technical issues associated with the success of EN-DCR, and clarifies the pros and cons of different pre- and postoperative procedures in adults with lower lacrimal pathway obstructions.

No MeSH data available.


Related in: MedlinePlus