The Modified Technique of External Dacryocystorhinostomy in the Management of Complicated Nasolacrimal Duct Obstruction

Abstract

Aim: To evaluate the outcome of the modified technique of external dacryocystorhinostomy (EDCR) with a "U"-shaped single flap that was fixed on to the orbicularis muscle with combined silicone tube in dacriostenosis. In cases with decreased visibility because of excessive bleeding during surgery, a small sac size, and difficulty of mutual suturing between nasal mucosal and sac flaps related to distance. Methods: This retrospective study included 118 patients with a nasolacrimal duct obstruction who underwent the modified technique of EDCR. The modified EDCR procedure envisions the creation of anastomosis of the single anterior "U"-shaped flaps suturing anterior flaps of the lacrimal sac and nasal mucosa. The sutured flap was fixed on to the orbicularis muscle. The silicone tube intubation was performed on all patients. Results: The average age of the patients was 39±19.2 (9-70) years, including 94 women and 24 men. The average follow-up time was 18±4.5 (9-36) months. Total 112 eyes (94.9%) showed a patent lacrimal system to irrigation, whereas 6 eyes (5.1%) had recurrence of epiphora and not patent lacrimal system to irrigation by the end of the first surgeries. The same surgery was planned for these patients. The patent lacrimal system was achieved in 3 of these 6 eyes. The overall success rate of the surgical procedure used in this study was 97.4%. Conclusions: This modified technique of EDCR with a "U"-shaped single anterior flaps that was fixed on to the orbicularis muscle with combined silicone tube simplifies the surgical procedure and is effective in the management of nasolacrimal duct obstruction. © 2016 Mutaz B. Habal, MD.