Assessing Curved Foraminotomy Rongeurs as an Effective Tool in Osteotomy Formation during Endoscopic...

Area of Science:

• Ophthalmology
• Otorhinolaryngology
• Surgical Anatomy

Background:

• Endoscopic dacryocystorhinostomy (endo-DCR) aims to create an osteotomy for tear drainage.
• The frontal process of the maxilla often limits access, necessitating powered instruments.
• Curved foraminotomy rongeurs may offer improved surgical access and ostium formation.

Purpose of the Study:

• To evaluate the efficacy of curved foraminotomy rongeurs in enhancing bone removal and lacrimal sac exposure during endo-DCR.
• To compare the outcomes of using standard rongeurs versus combined standard and curved rongeurs.

Main Methods:

• Endo-DCR procedures were performed on 12 fresh frozen cadavers (24 sides).
• Bone removal and lacrimal sac exposure were measured after using standard rongeurs and subsequently with curved foraminotomy rongeurs.
• Statistical analysis using the Wilcoxon signed-rank test compared bone mass removed and percentage of sac exposure.

Main Results:

• Standard rongeurs removed a median of 229.5 mg bone, exposing 60% of the lacrimal sac.
• Addition of curved foraminotomy rongeurs significantly increased bone removal to a median of 449.5 mg (P < 0.0001) and lacrimal sac exposure to 90% (P < 0.0001).

Conclusions:

• Curved foraminotomy rongeurs significantly enhance bone removal during endo-DCR.
• These instruments provide greater lacrimal sac exposure, representing a promising advancement in endo-DCR surgical instrumentation.