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Abstract ID: 24-165
Three “tricky” situations encountered during endoscopic endonasal dacryocystorhinostomy
Zoran Zikic
Purpose
Description of three circumstances, during endoscopic endonasal dacryocystorhinostomy (endo DCR), which have made the surgery more difficult and more time consuming. The aim of the presentation is to bring attention to these potential events, during endoscopic endonasal lacrimal procedures.
Methods
All three cases were examined preoperatively by a standard lacrimal assesment, because of epiphora and / or discharge from the inner canthal area. In addition to this a preoperative endonasal endoscopic exam was performed. Endo DCR was the procedure of choice in all the cases, based on the clinical findings and patient preference. The surgical procedures were documented by video recording of the feed from the endoscope camera.
Results
In the first case, an enlarged agger nasi cell was noted on preoperative nasal endoscopy, and confirmed by a CT scan. During surgery, in order to reach the lacrimal sac, a subtotal excsision of the enlarged air cell had to be performed, after which an apparent absence of the usual anatomical landmarks was noted. The lacrimal sac was identified by passing a probe through the upper canaliculus and tenting it.In the second patient, after incising the denuded lacrimal sac mucosa, passage of the probe from the upper punctum encountered an obstruction. Initially it resembled a membrane at the common canalicular opening. After several attempts of teasing in the probe, a small dacryolith was dislodged endonasaly. With the probe in the nasal space, the endosac lumen was explored using the aspirating periosteal elevator, revealing a diverticulum of the sac lumen, from which a much larger dacryolith was dislodged. In the third case, following posterior flap relaxing incisions of the lacrimal sac, an elastic tissue was caught in the aspiration port, which turned out to be orbital fat. None of the described cases had postoperative complications.
Conclusion
A proper preoperative clinical assesment, aided by nasal endoscopy and imaging can identify some of the factors which may complicate and endo DCR, whereas some complications may arise due to an adverse event during the surgery.
Additional Authors
Isidora Janicijevic – 1.Milos Eye Clinic, Belgrade, Serbia 2. Eye Clinic, University Hospital Zvezdara, Belgrade, Serbia
Andjela Pusonja – 1.Milos Eye Clinic, Belgrade, Serbia 2. Eye Clinic, University Hospital Zvezdara, Belgrade, Serbia
Nina Todorovic – 1.Milos Eye Clinic, Belgrade, Serbia 2. Eye Clinic, University Hospital Zvezdara, Belgrade, Serbia