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【Otolaryngology endoscopy】Nasal dacryocystostomy under nasal endoscope

Released on May. 16, 2022

Nasal dacryocystostomy under nasal endoscope is suitable for chronic dacryocystitis, long-term epiphora or pus, normal upper and lower punctum, and dacryocystography shows that the lacrimal sac is cystic.

Surgical methods:

Surgery was performed with enhanced local anesthesia. Under the guidance of a 0° nasal endoscope, with the attachment border of the middle turbinate and the inferior turbinate as the upper and lower boundaries, and the base of the uncinate process as the posterior boundary, the mucoperiosteal was stripped forward and excised, and an osteotome was used to make a 1.0x0.8cm² bone. window. The medial wall of the lacrimal sac is fully exposed and incised to form a tongue-shaped flap with a base underneath. Then suture it down and fix it on the inferior turbinate. After the operation, dexamethasone plus erythromycin eye ointment gauze was applied locally to stop bleeding. The nasal packing was removed the next day, the lacrimal duct was rinsed twice a day, and the patient was discharged in about 5 days.

Surgical steps:

1. Positioning the lacrimal sac: Use gun-shaped forceps to place the two leaves inside and outside the nasal cavity, respectively, and place the tip inside and outside the nasal cavity, respectively, to measure the upper and lower boundaries of the lacrimal sac, and the posterior boundary is the attachment of the front end of the uncinate process.

2. At the front end of the middle turbinate, with the uncinate process as the posterior boundary, a transverse portal-shaped mucoperiosteal flap is made forward and downward, or the mucosa and periosteum of the projection area of the lacrimal sac are removed.

3. Use an electric drill or osteotome to remove part of the maxillary frontal sinus and lacrimal bone in the projection area of the lacrimal sac, and open a bone window with a diameter of 1 cm to expose the lacrimal sac wall.

4. Insert the lacrimal duct probe into the lacrimal sac through the punctum, move the probe and observe under the endoscope whether there is a lacrimal sac outside the bone window.

5. Cut the lacrimal sac wall with a sickle or scissors. The lacrimal sac wall corresponding to the bone window can be excised, or cut into a U-shaped flap that is turned down or turned to cover the corresponding bone margin.

6. After rinsing the lacrimal sac and the nasal cavity wound, insert a silicone dilation tube through the punctum, lead out through the nasostomy, and fix it on the lateral wall of the nasal cavity. It is also possible not to place a silicone dilation tube, but to pack it with a small piece of inflatable sponge (with a thread at the tail) to dilate the dacryocystostomy.

7. If the bleeding is completely stopped, the nasal cavity can not be packed. If there is clear bleeding, it can be filled with gelatin sponge, expansion sponge or oil gauze.

Nasal dacryocystostomy under nasal endoscope has the advantages of simple operation, clear vision, and less bleeding, so it is easier to master. It does not damage the medial canthal ligament and the orbicularis oculi muscle, and has minimal damage to the surrounding tissues such as the lacrimal sac. This will help to further improve the success rate of surgery.

In addition, endoscopic dacryocystostomy does not make facial incisions and has no effect on appearance, which is in line with people's pursuit of beauty. In addition, the patients suffered less pain, recovered quickly after surgery, and the hospital stay was shortened by more than half compared with the control group, so it was easier for the patients to accept. It is a more ideal method for the treatment of chronic dacryocystitis.