Submucosal Uncinectomy: An Adjunct to Endoscopic Endonasal Dacryocystorhinostomy

Epiphora occurs either because of mechanical obstruction of the lacrimal drainage system or caused by lacrimal pump failure. Dacryocystorhinostomy is the surgical intervention for epiphora resulted due to obstruction of nasolacrimal duct. The operative approach can be either external or endonasal. The endoscopic endonasal dacryocystorhinostomy (EEDCR) was introduced in late 1800s. The key to successful outcome is wide exposure of lacrimal crest and proper apposition of flaps to prevent restenosis. Our study is intended to showcase the advantages of submucosal removal of uncinate bone during EEDCR.

This is a prospective randomised interventional study conducted on 59 patients with epiphora and proximal nasolacrimal duct obstruction. Major Pre-op examinations included irrigation tests and endoscopic examination of nasal cavity. The patients were divided into two groups: Group-A(28 patients) underwent routine DCR surgery with classical mucosal flap overlapping, and Group-B(31 patients) underwent EEDCR with submucosal uncinectomy.

Subjective improvement at 3-month follow-up showed that 30/31 patients in Group-B (96.7%) and 21/28 patients in Group-A (75%) had fully improved. While objective improvement at 3 month shows 22 patients in Group-A(78.5%) had full improvement and 31 patients in Group-B 100% had full improvement. The difference in the results of both groups is statisctically significant.

The submucosal uncinectomy during DCR surgery is a simple modification of existing technique which helps in proper marsupialization of lachrymal-sac and cover all raw area with mucosa, thus preventing stenosis of neo-ostium. This in turn improves the outcome of the surgery.