Limits...
Entire lacrimal sac within the ethmoid sinus: outcomes of powered endoscopic dacryocystorhinostomy.

Ali MJ, Singh S, Naik MN - Clin Ophthalmol (2016)

Bottom Line: At a mean follow-up of 6.6 months, anatomical and functional success were observed in 93.3% (14 of 15).One patient showed failure secondary to cicatricial closure of the ostium.An entire sac within an ethmoid sinus poses a surgical challenge.

View Article: PubMed Central - PubMed

Affiliation: Institute of Dacryology, LV Prasad Eye Institute, Hyderabad, India.

ABSTRACT

Background: The aim of this study was to report the outcomes of powered endoscopic dacryocystorhinostomy (PEnDCR) in patients with lacrimal sac within the sinus.

Materials and methods: Retrospective analysis was performed on all patients who underwent PEnDCR and were intraoperatively documented to have complete lacrimal sac in sinus. Data collected included demographics, clinical presentations, associated lacrimal and nasal anomalies, intraoperative findings, intraoperative guidance, complications, postoperative ostium behavior, and anatomical and functional success. A minimum follow-up of 6 months postsurgery was considered for final analysis.

Results: A total of 17 eyes of 15 patients underwent PEnDCR using standard protocols, but with additional intraoperative guidance where required and careful maneuvering in the ethmoid sinus. The mean age of the patients was 37.2 (range 17-60) years. Of the unilateral cases, 69% (nine of 13) showed left-side predisposition; 80% of patients showed regurgitation on pressure over the lacrimal sac area. Associated lacrimal and nasal anomalies were observed in 13.3% (two of 15) and 40% (six of 15), respectively. At a mean follow-up of 6.6 months, anatomical and functional success were observed in 93.3% (14 of 15). One patient showed failure secondary to cicatricial closure of the ostium.

Conclusion: An entire sac within an ethmoid sinus poses a surgical challenge. Good sinus-surgery training, thorough knowledge of endoscopic anatomy, careful maneuvering, and use of intraoperative navigation guidance result in good outcomes with PEnDCR.

No MeSH data available.


Related in: MedlinePlus

Endoscopic view of the right nasal cavity.Notes: Lacrimal sac (arrow) in close vicinity of the frontal sinus recess (A). Close-up view showing the recess more clearly (B). Postoperative endoscopic view showing the pseudocicatrix (shown by the probe) all around with a small window (C). Close-up view through the window demonstrates a posterior and lateral ostium with positive fluorescein endoscopic dye test (D).Abbreviation: FR, frontal sinus recess.
© Copyright Policy
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4940020&req=5

f2-opth-10-1199: Endoscopic view of the right nasal cavity.Notes: Lacrimal sac (arrow) in close vicinity of the frontal sinus recess (A). Close-up view showing the recess more clearly (B). Postoperative endoscopic view showing the pseudocicatrix (shown by the probe) all around with a small window (C). Close-up view through the window demonstrates a posterior and lateral ostium with positive fluorescein endoscopic dye test (D).Abbreviation: FR, frontal sinus recess.

Mentions: A lacrimal sac can be labeled a “complete sac in sinus” when it lies in its entirety within the boundaries of the sinuses, mostly the ethmoid (Figure 1A–C). The definitive diagnosis of such a sac in the sinus is established intraoperatively; however, preoperative examination may provide a few clues that may be suggestive of at-risk patients. The authors observed that their cohort had patients with steep nasal bridges, deeply set eyes, and posterior insertion of medial canthal tendons. However, a large series is required to confirm this association. Intraoperatively, a flatter frontal process of the maxilla along with middle turbinate malpositions may provide useful clues (Figure 1A and B). Intraoperative guidance in the form of image guidance or transcanalicular light source was helpful in delineating the entire anteroposterior and superoinferior extent of the lacrimal sac within the ethmoid sinus (Figure 1D–F). Occasionally, the lacrimal sac may be found superoposteriorly in close relation to the frontal recess and frontal sinus-outflow pathways (Figure 2A and B). This has been observed more commonly following trauma.17


Entire lacrimal sac within the ethmoid sinus: outcomes of powered endoscopic dacryocystorhinostomy.

Ali MJ, Singh S, Naik MN - Clin Ophthalmol (2016)

Endoscopic view of the right nasal cavity.Notes: Lacrimal sac (arrow) in close vicinity of the frontal sinus recess (A). Close-up view showing the recess more clearly (B). Postoperative endoscopic view showing the pseudocicatrix (shown by the probe) all around with a small window (C). Close-up view through the window demonstrates a posterior and lateral ostium with positive fluorescein endoscopic dye test (D).Abbreviation: FR, frontal sinus recess.
© Copyright Policy
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940020&req=5

f2-opth-10-1199: Endoscopic view of the right nasal cavity.Notes: Lacrimal sac (arrow) in close vicinity of the frontal sinus recess (A). Close-up view showing the recess more clearly (B). Postoperative endoscopic view showing the pseudocicatrix (shown by the probe) all around with a small window (C). Close-up view through the window demonstrates a posterior and lateral ostium with positive fluorescein endoscopic dye test (D).Abbreviation: FR, frontal sinus recess.
Mentions: A lacrimal sac can be labeled a “complete sac in sinus” when it lies in its entirety within the boundaries of the sinuses, mostly the ethmoid (Figure 1A–C). The definitive diagnosis of such a sac in the sinus is established intraoperatively; however, preoperative examination may provide a few clues that may be suggestive of at-risk patients. The authors observed that their cohort had patients with steep nasal bridges, deeply set eyes, and posterior insertion of medial canthal tendons. However, a large series is required to confirm this association. Intraoperatively, a flatter frontal process of the maxilla along with middle turbinate malpositions may provide useful clues (Figure 1A and B). Intraoperative guidance in the form of image guidance or transcanalicular light source was helpful in delineating the entire anteroposterior and superoinferior extent of the lacrimal sac within the ethmoid sinus (Figure 1D–F). Occasionally, the lacrimal sac may be found superoposteriorly in close relation to the frontal recess and frontal sinus-outflow pathways (Figure 2A and B). This has been observed more commonly following trauma.17

Bottom Line: At a mean follow-up of 6.6 months, anatomical and functional success were observed in 93.3% (14 of 15).One patient showed failure secondary to cicatricial closure of the ostium.An entire sac within an ethmoid sinus poses a surgical challenge.

View Article: PubMed Central - PubMed

Affiliation: Institute of Dacryology, LV Prasad Eye Institute, Hyderabad, India.

ABSTRACT

Background: The aim of this study was to report the outcomes of powered endoscopic dacryocystorhinostomy (PEnDCR) in patients with lacrimal sac within the sinus.

Materials and methods: Retrospective analysis was performed on all patients who underwent PEnDCR and were intraoperatively documented to have complete lacrimal sac in sinus. Data collected included demographics, clinical presentations, associated lacrimal and nasal anomalies, intraoperative findings, intraoperative guidance, complications, postoperative ostium behavior, and anatomical and functional success. A minimum follow-up of 6 months postsurgery was considered for final analysis.

Results: A total of 17 eyes of 15 patients underwent PEnDCR using standard protocols, but with additional intraoperative guidance where required and careful maneuvering in the ethmoid sinus. The mean age of the patients was 37.2 (range 17-60) years. Of the unilateral cases, 69% (nine of 13) showed left-side predisposition; 80% of patients showed regurgitation on pressure over the lacrimal sac area. Associated lacrimal and nasal anomalies were observed in 13.3% (two of 15) and 40% (six of 15), respectively. At a mean follow-up of 6.6 months, anatomical and functional success were observed in 93.3% (14 of 15). One patient showed failure secondary to cicatricial closure of the ostium.

Conclusion: An entire sac within an ethmoid sinus poses a surgical challenge. Good sinus-surgery training, thorough knowledge of endoscopic anatomy, careful maneuvering, and use of intraoperative navigation guidance result in good outcomes with PEnDCR.

No MeSH data available.


Related in: MedlinePlus