Osteotome as an adjunctive instrument in endoscopic dacryocystorhinostomy

To report the novel use of the osteotome as an adjunctive instrument in Endoscopic Dacryocystorhinostomy (DCR).

A retrospective interventional case series of 15 patients, underwent endoscopic DCR at the Singapore National Eye Centre, by a single ophthalmologist and rhinologist between April 2009 and April 2011.All patients' case records were reviewed and the information recorded included: patients' demographics, level of obstruction of the lacrimal system, operative time, postoperative symptoms and complications (if any), and the length of follow-up. All patients had preoperative syringing to determine the level of obstruction, and had postoperative syringing only if there were any complaints of epiphora.All surgeries were recorded on video. The osteotome and mallet were used in all patients to augment the bone removal, and Crawford stent (MIRA®) intubation was done in all patients and left in situ for 2 months.

A total of 15 patients were reviewed and analyzed from April 2009 to August 2010. Ages ranged from 22 to 77 years of age underwent endoscopic DCR with Crawford stent (MIRA ®) intubation. All patients had syringing before surgery and all had only nasolacrimal duct obstruction except 1 patient who had common canalicular obstruction. The surgery was carried out as described above with no intraoperative or postoperative complications in any of the patients. Duration of surgery ranged from 22 to 65 minutes with a mean time of 42.6 minutes. All patients were followed up from 2 to 11 months with resolution of epiphora in all cases.

The use of the osteotome and mallet, in combination with the Kerrison rongeur and diamond drill, has been found to be useful in creating a large osteotomy in endoscopic DCR. It has allowed greater ease and speed in performing this procedure, especially for patients with thicker bone and narrower nasal cavities.