Dacryocystorhinostomy: a modification of the Dupuy-Dutemps operation

In a series of 112 cases, dacryocystorhinostomy with direct anterior and posterior flap anastomosis has produced a success rate of 94%. Modifications from the original procedure described by Dupuy-Dutemps include preparation of the lacrimal sac flaps and preplacement of the sutures prior to the osteotomy which facilitates accurate identification and approximation with the nasal flaps. Adaptic gauze impregnated with polysporin ointment is packed into the rhinostomy site and out to the anterior nares to maintain patency and minimize clot and membrane formation. Common canalicular stenosis must be recognized and treated with silicone intubation to prevent failure in an otherwise correctable situation.