Anterior single flap external dacryocystorhinostomy: outcome in 200 Sudanese patients

AIM: To present the outcome of anterior single flap external dacryocystorhinostomy (DCR) in Sudanese patients. METHODS: The data of 200 consecutive patients were retrospectively analyzed, who had anterior single flap external DCR with a minimum of one year follow-up. The surgeries were performed by the same surgeon (the first author) and patients were followed up for one year postoperatively. Presence of epiphora at the end of one year and no response to syringing and probing was considered failure. RESULTS: The mean age of the study sample was 29.7 years (ranged 4-65 years). The ratio of male to female was 1∶2. The success rate was 98%. Failure was reported in 4 patients, two of them were traumatic cases with preexisting orbital disfigurement. CONCLUSION: This study adds on to the evidence of the usefulness of anterior single flap DCR. Although it is simpler and easier to master the technique, this procedure showed a success rate comparable to that of the conventional method in literature.     

Pediatric Endoscopic Dacryocystorhinostomy Failures: Who and Why?

OBJECTIVE: The objectives of this study are to report outcomes of pediatric patients with nasolacrimal duct obstruction (NLDO) who underwent primary endoscopic dacryocystorhinostomy (DCR) and discuss causes of failure. STUDY DESIGN: The authors conducted a retrospective case series. METHODS: Charts of all patients less than 16 years of age who underwent primary endoscopic DCR from 1997 to 2004 were reviewed. Patients were grouped based on the presence or absence of facial anomalies or syndromes and whether the NLDO was congenital or acquired. Success was defined as complete resolution of symptoms, improvement included anatomic patency or partial symptoms, and failure as no improvement or demonstration of patency. RESULTS: Thirty-four patients (43 ducts) aged 11 months to 14 years were identified. There were 17 males and 17 females. Follow up ranged from 2 to 54 months (average, 21 months). Twenty-four patients (29 ducts) had congenital NLDO, seven patients (11 ducts) had congenital syndromes associated with craniofacial abnormalities, and three patients (three ducts) had acquired NLDO. In patients with congenital NLDO without craniofacial abnormalities or syndromes, 22 of 29 eyes (76%) were cured with another three (10%) showing improvement. Only one of 11 (9%) eyes of patients with congenital craniofacial abnormality or syndrome experienced complete resolution and only four of 11 (36%) eyes showed improvement. Of the patients with acquired NLDO, two of three (67%) of the eyes were cured and one (33%) improved. CONCLUSIONS: Endoscopic DCR is safe and effective for most children, although patients with craniofacial abnormalities or syndromes are extremely difficult to cure.     

Comparative Analysis of Laser Assisted Endoscopie and Conventional Endoscopie Dacryocystorhinostomy

Background

Dacryocystorhinostomy (DCR) is the standard surgical treatment for epiphora caused by obstructions distal to the common canaliculus. Endoscopic DCR (EDCR) and laser assisted DCR (LAEDCR) are becoming increasingly popular alternatives.

Method

69 cases of EDCR were compared with 18 cases of LAEDCR. The success rates were noted at 01 week, 01, 03 and 06 months. The operating time required, incidence of adjuvant procedures, complications and post operative morbidity were recorded.

Results

At the end of 06 months, 100% and 95% success was achieved with LAEDCR and EDCR respectively. Operating time, complication rates and the incidence of adjuvant procedures required were lesser in the LAEDCR group.

Conclusion

In our study both the procedures have comparable success rates, though LAEDCR has an edge over EDCR in terms of decreased duration of surgery, decreased post operative morbidity and lesser complications.Key Words: Epiphora, endoscopic dacryocystorhinostomy, laser assisted endoscopic dacryocystorhinostomy     

巴曲亭局部应用在鼻腔泪囊吻合术中的止血效果观察

目的观察巴曲亭（蛇毒血凝酶）局部应用在鼻腔泪囊吻合术中的止血效果。方法60例慢性泪囊炎患者随机均分为巴曲亭治疗组和止血敏对照组,术前检测血浆凝血酶原时间（PT）、活化部分凝血酶原时间（APTT）、纤维蛋白原（FIB）,观察局部用药后的术中止血效果,比较两组患者的术中出血量。结果巴曲亭组术中出血量显著减少,与对照组比较差异有显著性（P〈0．01）。结论巴曲亭局部应用可显著减少鼻腔泪囊吻合术中的出血量、保持术野清晰,可作为鼻腔泪囊吻合术中局部应用的止血药物。     

Endoscopic inferior dacryocystorhinostomy

Conventional dacryocystorhinostomy (DCR) usually involves extensive removal of bone at the lacrimal fossa and hence risks disruption of the lacrimal pump mechanism. A physiological operation for nasal lacrimal blockage is described whereby only the inferior portion of the lacrimal sac and the adjacent duct are marsupialized into the nose. The operation is safe, quick and does not involve sophisticated instruments. Result of 81 consecutive endoscopic inferior DCRs reveals a success rate of over 90% which is maintained with time. Most patients had a wide lacrimal window with preserved lacrimal pump movement at the superior sac remnant.     

Bilateral congenital lacrimal fistulas in an adult as part of ectrodactyly-ectodermal dysplasia-clefting syndrome: A rare anomaly

Ectrodactyly-ectodermal dysplasia and clefting syndrome or “Lobster claw” deformity is a rare congenital anomaly that affects tissues of ectodermal and mesodermal origin. Nasolacrimal duct (NLD) obstruction with or without atresia of lacrimal passage is a common finding of such a syndrome. The authors report here even a rarer presentation of the syndrome which manifested as bilateral NLD obstruction and lacrimal fistula along with cleft lip and palate, syndactyly affecting all four limbs, mild mental retardation, otitis media, and sinusitis. Lacrimal duct obstruction and fistula were managed successfully with endoscopic dacryocystorhinostomy (DCR) which is a good alternative to lacrimal probing or open DCR in such a case.     

Otologic T-tube in endonasal dacryocystorhinostomy: a new approach

Conclusion. Otologic T-tubes had a success rate of 73% if implanted during endoscopic dacryocystorhinostomy (DCR). We suggest that they can be used successfully in endoscopic DCR, and are promising as an alternative to silicone stent intubations. Objective. To evaluate the efficacy of endoscopic DCR using otologic T-tube. Materials and methods. Twenty patients (22 eyes) with nasolacrimal duct obstruction underwent endoscopic DCR. After creating an aperture in the medial wall of the lacrimal sac, the otologic T-tube (1.15 mm diameter, Invotec, Jacksonville, FL, USA) was inserted into the sac transnasally. The T-tube was left in the lacrimal sac for between 3 and 6 months. The patients were followed up for between 6 and 24 months (mean 12.4 months). The improvement in patients’ epiphora complaint was grouped as very good, good, or no change. Results. Eleven eyes (50%) proved to be ‘very good’, whereas five eyes (23%) were good, and six eyes (27%) had no change. Of six eyes that were reported to have no change after the operation, three experienced spontaneous tube loss in the early period, one eye was a recurrent case, and the other two were primary cases.     

鼻泪管逆行置管手术与泪囊鼻腔吻合术的对比观察

目的：探讨鼻泪管逆行置管手术治疗慢性泪囊炎、鼻泪道阻塞的临床疗效及其实用价值。 方法：回顾性追踪观察32例行泪囊鼻腔吻合术及35例行鼻泪管逆行置管术的术后3~12mo的疗效。 结果：鼻泪管逆行置管手术组治愈率为94%。鼻腔泪囊吻合术组治愈率为94%。两组疗效经统计学分析差异无显著性,但鼻泪管逆行置管手术操作时间显著小于鼻腔泪囊吻合术（P<0.001）,且术中术后并发症少。 结论：鼻泪管逆行置管手术是一种疗效确切、简便、经济,宜于推广的治疗方法。     

Malignant apocrine sweat gland carcinoma of the caruncle

A 34-year-old male presented with a mass in the medial aspect of the orbit. Histological examination demonstrated a malignant apocrine sweat gland carcinoma, which we consider to be most likely derived from the caruncle. We describe the clinical, radiological and histological features, with management options and a review of the relevant literature regarding sweat gland carcinomas.