[The Heermann modification of intranasal microsurgery in lacrimal duct stenoses]

The authors demonstrated Heermann's modification of intranasal microsurgery on the tearways. Since 1912 all intranasal lacrimal sac operations at the Krupp Hospital (up to 98 cases yearly) have been performed according to Randolph and West (1909). During the last 36 years our patients have been operated on in a semisitting-(Fowlers)-position with the help of the binocular microscope and with hypotensive anaesthesia. This technique of lacrimal sac surgery is demonstrated "step-by-step" with the removal of the medial wall of the lacrimal sac in abscesses or dacryoliths. In rare cases of a presaccal stenosis, a circular resection of the stenosis after J. Heermann (1989/1991) was done to leave the common duct open by the retraction of the scar. That is the reason why the insertion of plastic prostheses is rarely necessary (only in patients with congenital aplasia or extensive stenosis of the horizontal lacrimal duct). Funnel-shaped prostheses of glass were developed in 1925 by J. Heermann sen., of steel 1930 by H. Heermann and made by plastic material 1966 by J. Heermann. During a ten-year period (1976-1986) we evaluated 659 cases of intranasal microsurgery on the tearways. The use of plastic prosthesis was necessary in 17 cases. Including reoperations (first operation after Toti) satisfactory results were obtained in 94% of all cases.