Endonasal microscopic dacryocystorhinostomy: results and advantages

The modern endonasal operative technique of functional fenestration of saccus lacrimalis in the middle nasal meatus (endonasal dacryocystorhinostomy), first described by West in 1910, has been gaining in significance over the past few years. At the VI National Congress of Otorhinolaryngology (1997) we presented for the first time in this country performance of endonasal microscopic dacryocystorhinostomy videotaped and started a routine use of this technique in our department.

We present the results of our 3-year experience with the technique.

Endonasal microscopic dacryocystorhinostomy was performed in 50 patients (57 operations) without stenting. The effect of the surgery was assessed by comparing the results of control examinations with the preoperative findings using the following criteria: subjective complaints, and objective findings--palpatory test, irrigation according to Anell, endoscopy of the nasal cavities and the neo-ostium.

Statistically significant improvement of specific subjective symptoms was obtained in 78.9%-100%. In 6 cases the closure of the neo-ostium was proven endoscopically.

Endonasal microscopic dacryocystorhinostomy preserves intact the normal function of the lacrimal pump, yields excellent cosmetic results and allows simultaneous management of the concomitant sino-nasal pathology. A neo-ostium under 2 mm in diameter can be conducive to postoperative epiphora. A congenital, untreated form of postsaccal stenosis with concomitant dacryocystitis as well as formation of synechiae are factors increasing the possibility of restenosis.