Silicone tubing is not necessary after primary endoscopic dacryocystorhinostomy: a prospective randomized study

BACKGROUND: Endoscopic dacryocystorhinostomy (EN-DCR) is an effective procedure when treating saccal and postsaccal obstructions of the nasolacrimal pathway. The benefit of silicone tubing after DCR is still controversial. We conducted a prospective, randomized study to evaluate the necessity of bicanalicular silicone tubes after primary EN-DCR. METHODS: Forty-six consecutive primary EN-DCR procedures were performed in 42 patients during 2004-2007. The patients were randomized into two study groups according to whether silicone tubing was used or not. RESULTS: The overall success rate after primary EN-DCR was 89%: with silicone tubes it was 78%, and without silicone tubes it was 100%. The difference between these two groups was statistically significant (p<0.049). The follow-up period was 6 months and included three follow-up visits: 1 week, 2 months, and 6 months postoperatively. If inserted, the silicone tubes were removed at the 2-month visit. CONCLUSION: The results of our prospective, randomized study showed that the use of silicone tubes after primary EN-DCR is not necessary.     

Endonasal dacryocystorhinostomy: a prospective study

Objective  The objectives of this study are to report the results of Endonasal Dacryocystorhinostomy (EnDCR) and the role of silicon intubation in EnDCR in Indian population. Study design  The authors conducted a prospective case series. Methods  290 patients underwent EnDCR between January 2002 and July 2007 — 240 cases without silicon intubation and 50 cases with silicon intubation. Patients were followed up for an average of 18.6 months in first group and 5.2 months in second group. Outcome was evaluated subjectively and objectively. Results  In EnDCR without silicon intubation, the procedure was successful in 93.3% of cases. In EnDCR with silicon intubation, the procedure was successful in 96% of cases. Conclusion  EnDCR is a safe procedure with good success rate and has potential advantages in chronic dacryocystitis cases. The use of silicon intubation in nasolacrimal pathway helps in maintaining the patency of rhinostomy.     

Prospective randomized comparison of endonasal endoscopic dacryocystorhinostomy and external dacryocystorhinostomy

Objectives and Study Design: The advent of the rigid endonasal endoscope and the development of functional endoscopic sinus surgery (FESS) technique have awakened interest in an endonasal endoscopic dacryocystorhinostomy (EESC-DCR) in treating nasolacrimal obstruction. This prospective, randomized study compares EESC-DCR with traditional external dacryocystorhinostomy (EXT-DCR) for their success rates, surgical duration, and postoperative symptoms. Patients and Methods: Sixty-four cases in 60 patients with primary acquired nasolacrimal sac or duct obstruction were divided into two subgroups by symptoms (simple epiphora/ chronic dacryocystitis). These patients were randomized within both subgroups into two operation groups. Altogether 32 EESC-DCRs and 32 EXT-DCRs were performed. The final follow-up visit was at 1 year. The patency of the lacrimal passage was investigated by irrigation and patients were questioned about their symptoms. Results: The success rate at 1 year after surgery was 75% for EESC-DCR and 91% for EXT-DCR after primary surgery. The difference was not statistically significant (P = .18). The success rate after secondary surgery with a follow-up time of 1 year was 97% in both study groups. The average duration for EESC-DCR was 38 minutes, and 78 minutes for EXT-DCR, (P < .001). Conclusions: EXT-DCR, when compared with EESC-DCR, appears to give a higher, although not statistically significant, primary success rate, but the secondary success rates are equal, indicating that these two different DCR techniques are acceptable alternatives.     

Transillumination-guided endoscopic endonasal dacryocystorhinostomy: Approach to revision cases and challenging anatomy

Dacryocystorhinostomy (DCR) is a surgical procedure in which a connection is established between the lacrimal sac and the nasal cavity in an effort to bypass an obstruction of the distal lacrimal apparatus. Endoscopic endonasal DCR (EEDCR) is a minimally invasive technique used to achieve this goal. In patients with altered anatomy, EEDCR can be challenging. Here, we describe the use of canalicular transillumination with EEDCR in three cases, and discuss the benefits of this technique.     

Topical Mitomycin C in functional endoscopic sinus surgery

In recent literature, there has been an interest in the use of Mitomycin C to reduce post-operative complications following endoscopic sinus surgery. We report our results on a prospective, randomized controlled trial involving 50 patients with chronic bilateral rhino sinusitis. We eliminated various confounding factors by studying a single group of patients, with symmetrical disease, without pre-existing gross anatomical abnormalities. Patients requiring revision sinus surgery were excluded. On completion of the surgery, a cotton pledget soaked in Mitomycin C was placed in one nostril (test) and saline-soaked pledget (control) was placed in the other side of the nose, both in the middle meatus. The side of the nasal cavity receiving the topical Mitomycin C was randomized. The patients were assessed periodically (first week, first month, third month and sixth month) for synechiae formation and presence or absence of their symptoms. At the first week follow up, there was a statistically significant difference in the incidence of synechiae between the saline and Mitomycin C side. Furthermore, there was a statistically significant improvement with regards to patient symptoms (nasal block and discharge) in the Mitomycin C side when compared to the saline side. At the third and sixth month, there was no difference between the two groups. The incidence of adverse tissue reaction (granulation, discharge, polypoidal mucosa and crusting) was less in the Mitomycin C side when compared to the saline side at the first month follow up. Topically applied Mitomycin C reduces the incidence of synechiae in the immediate post-operative period in patients undergoing endoscopic sinus surgery. There is also an improvement in nasal obstruction and discharge with a reduction in the incidence of adverse tissue reaction in the early post-operative period.     

Significance of adjunctive mitomycin C in endoscopic dacryocystorhinostomy

Purpose

The purpose of this study is to observe the effect of intraoperative topical application of mitomycin C (MMC) on the results of endoscopic dacryocystorhinostomy.

Design

This is a prospective, randomized, controlled, single-blind study.

Settings

Hospitalized treatment was done in a tertiary medical college hospital and research center that deals with a predominantly rural population.

Patients

Patients with primary acquired postsaccal obstruction causing chronic dacryocystitis were considered.

Methods

A total of 38 patients were randomized into either a mitomycin group or a control group. Both of these groups were subjected to an identical surgical procedure, except that 0.2 mg/dL of MMC was used in the mitomycin group, whereas normal saline was used in the control group. The follow-up period was at least 6 months. An asymptomatic patient with a visible stoma at nasendoscopy and free flow of saline into the nose with lacrimal syringing after 6 months after surgery was used as criteria for defining a successful result.

Results

The success rate was 82.3% when MMC was used and 85.7% among the controls (P > .05). Granulations, adhesions, and obliterative sclerosis occurred in a similar number of patients of both groups. However, granulations and adhesions did not have a bearing on the success rate in either group.

Conclusion

Mitomycin C did not appear to influence the occurrence of granulations, synechiae, or obliterative sclerosis, nor did it alter the success rate significantly.     

Endonasal endoscopic dacryocystorhinostomy in a four-month-old infant

The authors present a case of endonasal endoscopic dacryocystorhinostomy in a 4-month-old girl suffering from remarkable epiphora, persistent bulging and recurrent abscesses in the medial canthal region of the left eye. All conservative therapeutic attempts failed. Several external incisions were performed in order to solve the acute phases of the inflamed lacrimal sac. The procedure was performed by means of otologic microsurgical instruments under endoscopic control. No silicone stent was used. Ten months after surgery, the girl is doing very well.     

A study of 272 cases of endoscopic dacryocystorhinostomy

272 Patients with obstruction in nasolacrimal duct were treated by endoscopic nacryocystorhinostomy (DCR). The results were compared with that of external DCR and Endoscopic DCR without stent. In our study Endoscopic DCR with stening had better results. Endoscopic DCR with stenting has several advantages over the more conventional external approach and Endoscopic DCR without stenting. Results at 4 years of follow up have been good that is 98.6% patients were relieved of symptoms completely.     

Hammer-chisel technique in endoscopic dacryocystorhinostomy

We performed a prospective evaluation of endoscopic hammer-chisel dacryocystorhinostomy (DCR) procedures on 62 eyes of 44 patients (40 female and 4 male) with chronic epiphora or dacryocystitis (26 unilateral and 18 bilateral). The technique included chisel removal of bone over the lacrimal sac. The follow-up period was 12 to 54 months (mean, 28 months), and the patients' ages ranged from 17 to 67 years (mean, 35.5 years). The success rate of the consecutive endoscopic hammer-chisel DCR procedures was 87%. During operation, 8 patients had mild mucosal hemorrhage, which did not prevent the successful completion of the operation. Excellent patient tolerance was observed, with minimal morbidity and no major complications. As compared to the external approach, endoscopic hammer-chisel DCR is less traumatic, is less time-consuming, and is practical and cosmetically convenient, with minimal perioperative and postoperative complications. It also allows the simultaneous correction of any intranasal disease. It requires minimal instrumentation and is a relatively easy and fast technique.     

Chronic inflammation: a poor prognostic factor for endoscopic dacryocystorhinostomy

Endoscopic endonasal dacryocystorhinostomy (En-DCR) success can be affected by many factors. In this study, we aimed to determine the effect of chronic inflammation on the surgical outcome of En-DCR. A series of 25 primary En-DCR cases and their lacrimal sac specimens were involved in the study. The surgical outcomes were assessed subjectively (satisfied and unsatisfied) and objectively (successful and unsuccessful). All the specimens were examined for the chronic inflammation related histopathological features (inflammatory cell infiltration, fibrosis and capillary proliferation) and graded according to their severity. Moreover, a “chronic inflammation score” was established to determine the intensity of chronic inflammation using the grade of histopathological features. A quantitative and statistical analysis of histopathological features and chronic inflammation were performed between patients with satisfactory and unsatisfactory outcome; and patients with successful and unsuccessful outcome. The overall success rate according to subjective and objective assessment was 60%. However, 9 of 10 patients with unsatisfactory and/or unsuccessful outcome (90%) had severe chronic inflammation of lacrimal sac. In subjective assessment, inflammatory cell infiltration (p = 0.050), fibrosis (p = 0.037), capillary proliferation (p = 0.007) and chronic inflammation (p = 0.003) had a statistically significant difference between patients with satisfactory and unsatisfactory outcome. In objective assessment, statistically significant differences were detected between patients with successful and unsuccessful outcome when they compared according to inflammatory cell infiltration (p = 0.027), capillary proliferation (p = 0.007) and chronic inflammation (p = 0.003). Chronic inflammation related histopathological features of variable degree may have a role on En-DCR outcome. Chronic inflammatory score can be used as an indicator of En-DCR success.     

Endoscopic outcomes of resorbable nasal packing after functional endoscopic sinus surgery: a multicenter prospective randomized controlled study

Nasal packings can aid in control of postoperative bleeding and healing following functional endoscopic sinus surgery (FESS), but traditional non-resorbable stents have several inherent drawbacks. We performed a randomized, controlled, multicenter clinical trial to assess efficacy of resorbable nasal packing in patients undergoing FESS for chronic rhinosinusitis. A total of 66 patients for 88 nasal cavities were randomized to receive either hyaluronan resorbable packing (MeroGel^®) or standard non-resorbable nasal dressing after FESS. All underwent preoperative rhinoscopy, CT of sinuses, and, after surgery, were reassessed by rhinoscopy at 2, 4, and 12 weeks in blinded fashion. A total of 44 nasal cavities (MeroGel^®-group) received resorbable packing, whereas the remaining 44 were packed with non-resorbable nasal dressing. At follow-up endoscopic visit, the presence of nasal synechia was evaluated as primary outcome. Moreover, the tolerability and surgical handling properties of MeroGel^® and its comfort were assessed by surgeons and patients. Preoperative severity of rhinosinusitis was similar in both groups. No significant adverse events were observed in all patients. Follow-up endoscopy showed a lower proportion of nasal adhesions in MeroGel^®-group at both 4 (P = 0.041) and 12 weeks (P < 0.001). Moreover, an improvement of other endoscopic nasal findings such as re-epithelialization, presence of granulation tissue, and appearance of nasal mucosa of nasal cavities after FESS was observed in the MeroGel^®-group. Tolerability and surgical handling properties of MeroGel^® were positively rated by clinicians and the overall patient judged comfort of MeroGel^® was favorable. In conclusion, MeroGel^® can be considered a valid alternative to standard non-resorbable nasal dressings. It is safe, well-accepted, well-tolerated, and has significant advantage of being resorbable. Moreover, it may favor improved healing in patients undergoing FESS and reduce formation of adhesions.     

Revision dacryocystorhinostomy: a comparison of endoscopic and external techniques

BACKGROUND: Success rates for revision dacryocystorhinostomy (DCR) are lower than primary DCR. Scarring of the sac may limit the ability of the surgeon to achieve good nasal and lacrimal mucosa apposition. This study evaluates the comparative success rates of the external and endoscopic techniques for revision DCR. METHODS: Seventeen consecutive revision endoscopic DCRs (average age, 60.9 years) and 13 revision external DCRs (average age, 65.1 years) performed from January 1999 to December 2000 performed by separate surgeons were entered into the study. Patients with functional nasolacrimal and canalicular obstruction were excluded. The average follow-up was 11.1 months for the endoscopic DCR group and 10 months for the external DCR group. RESULTS: A successful DCR required complete relief of symptoms and an endoscopically determined anatomic patency of the nasolacrimal system. Revision endoscopic DCR surgery was successful in 76.5% of cases (13 of 17 cases) and external DCR surgery was successful in 84.6% (11 of 13 cases). This difference was not statistically significant. (p = 0.64, Fisher exact test with a two-tailed probability). CONCLUSION: Revision endoscopic DCR has a success rate of 76.5%, which compares favorably with that of the revision external DCR (84.6%).     

Concomitant nasal procedures in endoscopic dacryocystorhinostomy

Dacryocystorhinostomy (DCR) is the preferred treatment for lacrimal duct blockage. Endoscopic DCR has been practised increasingly in recent years as it avoids a facial scar and can be performed as a day procedure. Recent improvements in endonasal surgical technique led to success rates of up to 90 per cent. However, the endonasal approach often requires septal or turbinate surgery to optimze access to the lacrimal area. The incidence of concomitant procedures was investigated in 256 patients undergoing endonasal nonlaser DCR. In this study 55 out of 256 patients (21.5 per cent) required additional endonasal procedures to improve access to the lacrimal area. It is therefore advisable that otolaryngologists are involved in this procedure.     

Preincisional bupivacaine in posttonsillectomy pain relief: a randomized prospective study

OBJECTIVE: To determine the effect of preincisional bupivacaine hydrochloride infiltration on postoperative pain after tonsillectomy. DESIGN: Prospective, randomized, double-blind clinical trial. SETTING: A secondary/tertiary referral center in Christchurch, New Zealand. PATIENTS: A volunteer sample of 70 patients, aged 16 to 42 years, with recurrent tonsillitis. Seven patients were excluded. INTERVENTIONS: After randomization, one group received 5 mL of 0.5% bupivacaine hydrochloride in the peritonsillar space, with the patient under general anesthesia. The other group received 5 mL of isotonic sodium chloride solution, with the patient under general anesthesia. Both groups underwent surgery with a standardized surgical and anesthetic technique. MAIN OUTCOME MEASURES: Postoperative pain was assessed with a visual analog scale at 15 minutes and 1, 4, 12, 16, and 24 hours after the procedure. Postoperative analgesic requirement, length of admission, and antiemetic requirement were also assessed. RESULTS: No statistical difference was found between the 2 groups for postoperative pain by means of the visual analog scale at any time interval, nor was any statistical difference found for the other variables measured. A trend toward less pain in the immediate postoperative period in the group receiving bupivacaine was noted. CONCLUSION: No statistically significant benefit is found for use of preincisional bupivacaine in tonsillectomy.     

Drainage after thyroid surgery: a prospective randomized study.

Between November, 1996 and May, 1997 a series of 100 consecutive unselected patients undergoing all types of thyroid surgery--including even those inducing large dead space e.g. substernal goitre and carcinoma thyroid with recurrent nerve dissection--were randomly allotted to either receive drainage (n = 43) or not (n = 57). Patients with cervical dissection for lymph node metastasis were not included. Severe intra-operative haemorrhage was not a reason for exclusion. No complications such as haematoma or seroma were found in the undrained group whereas only minor complications such as haematoma (n = 4) were noted in the drained group. Whatever the group, none of the patients required re-exploration. The difference in overall hospital stay (1.72 days in the group of undrained patients versus 2.09 days in the drained group) was not statistically significant.