Systematic unciformectomy for a standardized endonasal dacryocystorhinostomy

Area of Science:

• Ophthalmology
• Otolaryngology
• Surgical Techniques

Background:

• Nasolacrimal duct obstruction (NLDO) causes epiphora and recurrent infections.
• Endonasal dacryocystorhinostomy (en-DCR) is a minimally invasive surgical approach to bypass the obstructed nasolacrimal duct.
• Standardization of surgical techniques is crucial for consistent outcomes in en-DCR.

Purpose of the Study:

• To present a standardized osteotomy technique for endonasal dacryocystorhinostomy (en-DCR).
• To evaluate the efficacy and safety of this standardized en-DCR method.
• To identify critical steps for successful lacrimal sac exposure during en-DCR.

Main Methods:

• A prospective, nonrandomized, interventional case series of 100 adult patients undergoing en-DCR.
• Standardized procedure included endoscopic assessment, common canaliculus diaphanoscopy, and endonasal osteotomy.
• Osteotomy involved anterior unciformectomy, lacrimal bone resection, and protected drilling; middle turbinate management was individualized.

Main Results:

• Direct lacrimal fossa localization achieved in 94% of cases via diaphanoscopy.
• Anterior uncinate process cleavage initiated osteotomy in 90% of cases, directly accessing the lacrimal fossa.
• Partial middle turbinate resection was required in 21% of cases; no septoplasty was performed.
• Perioperative bleeding occurred in 6% of cases; postoperative complications were infrequent and minor.

Conclusions:

• Anterior resection of the uncinate process is the most critical step for exposing the lacrimal fossa in en-DCR.
• Partial resection of the middle turbinate can be considered optional, depending on intraoperative findings.
• The described standardized osteotomy method is effective and safe for en-DCR, with a high rate of successful lacrimal sac exposure.