Using an endoscope, the dcr can be performed by endonasal route using either laser 4,5 or surgical instruments 6,7 or both. There is excellent illumination and magnification 2. Digital journal of ophthalmology 2015 volume 21, number 3 september 20, 2015 doi. Both kerrison punch and drill are widely used in endoscopic dcr with. Endonasal dcr can be performed with the help of rigid endoscopes or under binocular operating microscopes. Endonasal dcr was first completed in 1958 with the use of a microscope, and later the procedure used endoscope systems and lasers. Ct eartemporal bonepetrous ridges mercy medical center. Dacrocystorhinostomy dcr is an operation used to treat nasolacrimal duct obstruction. External versus endonasal dacryocystorhinostomy in a. For bone removal, kerrisons punch and dcr burr was used.
Abc endonasal cranial correction ecc is a proven and effective method that helps bring the body back into alignment through the correction of cranial bones out of place in a direction the body cannot selfcorrect. Several ophthalmologists fear performing dcr because of bleeding and unfamiliarity of structure. The introduction of endonasal laser dacryocystorhinostomy enldcr in the early 1990s showed great promise of changing dacryocystorhinostomy. Dacryocystorhinostomy dcr consists of creating a lacrimal drainage pathway to the nasal cavity to restore permanent drainage of previously obstructed. Using self retaining speculum one can work bimanually. Endonasal cranial correction advanced biostructural. Tsirbas and wormald are to be congratulated on their landmark paper in lacrimal surgery describing endonasal dacryocystorhinostomy dcr with mucosal flaps, 1 which is also known as powered endonasal dcr.
In good hands however, the scar is very inconspicuous. In recent years, threedimensional 3d printing has been mentioned throughout the media as a huge opportunity for industrial manufacturing and. Packaged in singleuse centrix syringe tips, accessflo saves time while eliminating crosscontamination. Disadvantages of endonasal dcr include the preferred use of general anesthesia by many surgeons, the high cost of expensive equipment and instrumentation, and the relatively steep learning curve for this procedure. Dear reader, enhancing the visualization of medical professionals is a core focal point for us at the medical technology business of zeiss. External in short, both techniques are highly successful. Twenty two patients were followed up in groupi and thirtysix patients were followed up in groupii. Paediatric endonasal endoscopic dcr seems to be an effective, safe and minimally invasive technique for the treat ment of mechanical nasolacrimal system obstruction. The light from the probe is visualized in the nose through a rigid nasal scope. Recently, advanced approaches utilizing tissue damage, the preservation. This potentially leads to cleaner surgical fields and improved surgical efficiency.
Endoscopic vs external dacryocystorhinostomycomparison. Depending on the preference of the surgeon, more postoperative care may be required for patients undergoing endonasal dcr than. Exdcr was first described by toti in 1904 and is the most widely practiced procedure. Article in classic viewepub betaprinter friendlycitation. Appropriate frame conditions provided, the respective procedures are safe and successful. This video demonstrates endoscopic dcr performed on a 57yearold female. Ct scanningsometimes called cat scanningis a noninvasive, painless medical test that helps physicians diagnose and treat medical conditions. Citrix fahig, unterstutzt pdf hintergrunde, wasserzeichen, als pdf netzwerk drucker. Endoscopic versus external approach dacryocystorhinostomy. His group also found the nasal approach more rapid and more acceptable to patients. A comparison of external and endoscopic endonasal dacryocystorhinostomy for acquired nasolacrimal duct obstruction r karim, r ghabrial, tf lynch, b tangschool of public health, faculty of medicine, university of sydney, sydney, australiapurpose. Fifty patients who underwent ext or enddcr between january 20102012 were involved in the study. Laser dcr laser dacryocystorhynostomycreating a new tear drain.
Dcr, or dacryocystorhynostomy, is a surgery performed to create a new tear drain between the eye and nose when your current tear drain becomes blocked or obstructed. Tears generated by the tear glands in your eyes need to be drained to the nose. The files of 165 patients who underwent endonasal dcr at a tertiary referral centre between 1991 and 2001 were retrospectively assessed. All instruments are handcrafted using the finest german quality stainless steel. The spiway is designed to help reduce mucosal trauma and keep the scope clean.
To compare success rates of external dacryocystorhinostomy dcr and endoscopic endonasal dcr for acquired. Mechanical endonasal dacryocystorhinostomy with mucosal flaps. The success rates for endonasal dacryocystorhinostomy. Laser transcanalicular endonasal dcr is also becoming popular due to its inherent advantages over endonasal laser delivery systems such as the laser direction being away from the globe and the approach being more familiar to the ophthalmic surgeon.
The study involved prospective interventional case series with short perioperative follow up. A questionnaire was applied to patients preoperatively, and. His dacryocystorhinostomy through an endonasal approach evaded popularity. Focusing on the endonasal approach, we compared success rates, clinical outcome, complications and patient satisfaction of endoscopic vs. Endonasal dcr is far superior than external dcr reason is simple and obvious. Jedmed has a full line of instrumentation for the endonasal dcr procedure. We analyzed the results of 173 patients who underwent an. An assessment of those significant reports about dcr techniques. Mri evaluation of lacrimal drainage after external and. Endoscopic dacryocystorhinostomy dcr has been the preferred treatment in the management of epiphora and many techniques were described by different. Endoscopic endonasal dacryocystorhinostomy dcr is the best, scar free no scar, lacrimal surgery performed for restoration of tears flow into the nose from the lacrimal sac, when the nasolacrimal duct tear duct has become blocked blocked tear duct tear duct obstruction abnormal tearing or epiphora watery eyes takes place due to obstruction in the.
Endoscopic endonasal dcr plays an established role in revision dcr surgery. Compared with external dcr, endoscopic dcr is more. The endonasal dcr technique uses a fiberoptic probe inserted in the punctum for guidance. Dcr is listed in the worlds largest and most authoritative dictionary database of abbreviations and acronyms the free dictionary. Efficacy of endo nasal dcr in primary nasolacrimal duct. Pdf endonasal dacryocystorhinostomy dcr without flap and. Despite much debate, many still believe that external dcr provides a high success rates than endoscopic dcr though many types of endonasal approaches have been attempted, long term success rates are less than ext. The main argument for an endonasal approach is the lack of a scar. You may also be prescribed antibiotic tablets or capsules. This is a new technique that involves creation of a large rhinostomy and mucosal flaps. Bicanalicular silicone stents in endonasal dcr american. Most of patients are females so if in any way a scar can be prevented over face will be a better option 4.
This article tries to provide few tips to make dcr easy and stressfree. Dacryocystorhinostomy dcr is performed in patients with saccal or postsaccal lacrimal duct obstruction. Complication rates were low in both types of surgery. All patients were operated on by same team of surgeons. Instructions following endonasal dcr surgery other medications pg2 eye drops, if prescribed, are instilled into the eye 3 times a day. Endolacrimal ktp laserassisted dacryocystorhinostomy. Nasal sprays may also be prescribed, and instructions about their use will be provided. Those corrections result not only in relief of residual tension around the skull but changes in the entire body. This approach allows the surgeon to deal with nasal adhesions, granulomatous tissue and hypertrophic turbinates at the same time. Long term success of endodcr with silicone tube catheter. During recent years endonasal dcr was developed as an alternative surgical technique. In the case of cicatricial obstruction at the osteotomy site, it is easier to perform endoscopic revision, and the patient is more likely to accept such a revision without visible external cuts. External dacryocystorhinostomy dcr is the most common and wellknown surgical method to restore the nasolacrimal system.
This study was done to assess the efficacy of powered endoscopic dacryocystorhinostomy dcr with creation of a large bony ostium exposing fundus of the sac and primary mucosal anastomosis. Endonasal dacryocystorhinostomy ota american academy of. Be sure that the net service is located in services. This study evaluates the preservation of lacrimal pump function in both procedures. External and endonasal dacryocystorhinostomy exdcr and endcr, respectively affect the tear drainage mechanism. It allows capturing images with an extremely high resolution and a 75. Longterm results of endonasal dacryocystorhinostomy. Despite ease and decreased morbidity of endonasal dcr, external dcr is procedure of choice as it is more successful.
Pooled results showed that both surgical approaches had similar success rates endoscopic endonasal dcr 82. Benign growths, sinonasal polyposis, septal deviations, allergic rhinitis, atrophic rhinitis, are all patients fit to be taken up for surgery, but since the pathology could be causative factor should be eliminated beforesimultaneously or after the. Comparison of endoscopic and external dacryocystorhinostomy for. The light from the probe is visualized in the nose through a rigid nasa.
Females have significantly smaller dimensions in the lower nasolacrimal fossa and middle nasolacrimal duct. Definition dacryocystitis is an inflammation of the tear sac lacrimal sac at the inner corner of the eye. To study the outcome of endonasal endoscopic dacryocystorhinostomy dcr with or without mucosal flap preservation, without mitomycin local application, silicon tube. They found a higher rate of success in the stent surgeries. This can be accessed though control panel administrative tools services. Dcr involves opening up your existing tear sac and connecting it directly into the nose to form a new tear drainage pathway. Operative and postoperative data were prospectively. Endonasal dcr may be useful in the management of acute dacryocystitis with abscess formation,10, 58 unlike external dcr, which is often considered to be contraindicated in this setting. The spiway is the first and only access guide for endoscopic endonasal skull base surgery. These prerequisites encompass appropriate technical equipment. The tear sac can be reached from inside the nose endonasal dcr or from the skin between your eye and nose. Published success rates for external dcr, endonasal dcr and endocanalicular laser dcr range widely from 50% to 99%. The study involved a prospective nonrandomised interventional case series with short perioperative follow up.
Primary acquired nasolacrimal duct obstruction is the commonest cause of chronic dacryocystitis presenting with symptoms like epiphora, discharge, irritation and pain. This requires removal of the small amount of bone that lies between your tear sac and your nose. To describe and assess the efficacy of mechanical endonasal dacryocystorhinostomy mendcr. Looking for online definition of dcr or what dcr stands for. From there, the tears travel through little tubelike structures canaliculi to the lacrimal sac.
The plugin will add command line options to nosetests. Pdf clinical outcome of endonasal ktp laser assisted. Current and future possibilities with printed model teeth. This included three patients with postoperative hemorrhage two who had endonasal dcr surgery and one having external dcr surgery.
The basic indication is same in all cases and either route can be used. Cases of successful endcr 4 patients and exdcr 4 patients were included. Dacryocystectomy definition of dacryocystectomy by. Endoscopic dacryocystorhinostomy oculoplastic eyelid. All planmeca cbct imaging units offer an imaging mode tailored for endodontics. Endonasal dcr should not be done when malignant tumour is in proximity of nldit is may be cause of obstruction. Also, these patients tend to be of an older age group that are not conscious of a small scar by the side of the eye. Description tears drain into little openings puncta in the inner corners of the eyelids. Our experience endonasal dacryocystorhinostomy is considered to be the standard treatment for chronic dacryocystitis, and is simple to perform and is very effective even in patients. Endonasal endoscopic dcr with full sac exposure is now considered the.
Dacryocystitis definition of dacryocystitis by medical. The endonasal dcr technique uses a fberoptic probe inserted in the punctum for guidance. Endoscopic endonasal dacryocystorhinostomy dcr is the best, scar free no scar, lacrimal surgery performed for restoration of tears flow into the nose from the lacrimal sac, when the nasolacrimal duct tear duct has become blocked blocked tear duct tear duct obstruction. Conventional dacryocystorhinostomy versus endonasal. External dacryocystorhinostomy dcr is the mainstay of treatment for this problem with a reasonable. We strive to help our users across a broad range of medical disciplines see more.
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