External Dacryocystorhinostomy, Success Rate and Causes of Failure in Endoscopic and Pathologic Evaluation

Hassan Ghasemi | Sajedeh Asghari Asl | Mohammad Ebrahim Yarmohammadi | Farhad Jafari | Pupak Izadi

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URL :   http://research.shahed.ac.ir/WSR/WebPages/Report/PaperView.aspx?PaperID=43364
Date :  2017/02/03
Publish in :    Iranian Journal of Pathology

Link :  http://ijp.iranpath.org/.
Keywords :External, Evaluation

Abstract :

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Backgrounds: External dacryocystorhinostomy (DCR) is the method of choice for treatment of nasolacrimal duct obstruction with which the other approaches are compared, with a failure rate of 4-13. The aim of this study is to assess the causes of failure in external DCR by postoperative endoscopic and pathological evaluation. Methods: In this retrospective cross-sectional study, 113 patients with external DCR and silicone intubation were followed up to 3 months. Silicone tubes were removed at the third months. Failure was confirmed based on the clinical findings and irrigation test. Paranasal sinus CT scanning and endoscopic and pathological evaluation was performed in failed cases. Results: Totally 113 patients underwent external DCR. The patients included 71 women and 42 men. Age range was 18- 86 years (mean 55.91 years). Epiphora was the most common complaint before surgery (90.3). Clinically, epiphora continued in 17 cases (15), of them 94.11 had at least one sinus CT abnormality and 82.35 had at least one endoscopic abnormality. The most common endoscopic findings were deviated septum (70.6), scar tissue (52.94), concha bullosa (46.9), septal adhesion (47.05), enlarged middle turbinate (41.2) and sump syndrome (11.7). The failure was significantly associated with the chronicity of the initial symptoms (p = 0.00). Pathologically, There were significant relationships between the failure rate and scar formation and allergic rhinitis (p=0.00 and 0.05 respectively). Conclusion: Preoperative endonasal evaluation and consult with an otolaryngologist can improve surgical outcomes and help a better conscious to intranasal abnormalities before external DCR surgery.