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Abstract ID: 24-152

Flap suturing endonasal dacryocystorhinostomy assisted by image-guided electromagnetic navigation system



In the external dacryocystorhinostomy (EX-DCR), a sutured anastomosis technique performed between the mucosa of lateral nasal wall and the lacrimal sac flaps is gold standard and is believed to lead to the success of the EX-DCR. However, in the endonasal DCR (EN-DCR), the bone reduction and the flap suturing in the small working space is technically challenging and time consuming. To address these disadvantages of the EN-DCR, we improved in three surgical technical points. (1) To present a simple and effective slip knot technique, in which the knot can easily be slid to the intranasal suturing point and tied automatically. (2) The precise bone reduction of the maxilla and lacrimal bone assisted by the image-guided electromagnetic navigation system (IGS) can provide the wide bony ostium with a conical shape. (3) The mucosa of lateral nasal wall is preserved sufficiently to make an anastomosis between the mucosa and the lacrimal sac anterior flap so that the sutured flap can cover the exposed bony wall. This report evaluated the flap suturing EN-DCR assisted by the IGS.


The retrospective review was performed of patients with primary nasolacrimal duct obstruction who underwent the IGS-assisted EN-DCR with the lacrimal sac flap sutured anastomosis (sutured group) and without the flap sutured anastomosis (non-sutured group). All surgeries were performed with the same surgeon from 2014 to 2023. The criteria for anatomical success were patency with syringing and a 70-degree endoscopic view of the ostium. The criteria for functional success were visualization of fluorescein dye at the ostium and relief from epiphora. The surgical outcome was regarded as a success when all of these criteria were satisfied. The evaluation was performed at 6 months postoperatively.


The surgical success was obtained in all patients of the sutured group (139 cases), whereas a 94.7% success rate in the non-sutured group (38 cases). The ostium size in the sutured group was statistically significantly larger than those in the non-sutured group.


The flap suturing EN-DCR assisted by the IGS may improve the postoperative ostium size.

Additional Authors

Kana Takahashi – Takahashi ENT&Eye Clinic

– Takahashi ENT&Eye Clinic