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Endoscopic views of bilateral dacryocystorhinostomies.

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We evaluated a 50-year-old man with a history of recurrent sinusitis. Computed tomography (CT) of the sinuses revealed chronic bilateral ethmoid sinusitis with totally opacified ethmoid cells. The patient underwent bilateral endoscopic ethmoidectomies. At the time of surgery, bilateral openings were found lateral to the insertion of the middle turbinates (figure, A and B). Gentle probing revealed a patent passage toward the medial canthus of the eye (figure, C). Transillumination with a 0[degrees] telescope inserted into the passage confirmed patent dacryocystorhinostomies (DCRs) bilaterally (figure, D).

The patient underwent endoscopic ethmoidectomies bilaterally. Care was taken not to interfere with the previously performed DCRs or damage the mucosa in the area of the rhinostomies. The sinus surgery was completed without complications.

The lacrimal apparatus consists of two canaliculi in the upper and lower eyelids that drain tears into the lacrimal sac and ultimately into the nose through the nasolacrimal duct. Patients who have an obstruction of the lower portion of the system can benefit from DCR with the creation of a new direct communication that is made into the nasal cavity from the lacrimal sac. The preferred location of this opening is roughly anterior and superior to the attachment of the middle turbinate where the bone is thinner. There can be significant variation in the location of the drainage site in the area of the middle meatus and the middle turbinate. (1,2)

When previous DCRs have been performed in a patient who is undergoing eventual endoscopic sinus surgery, it is important to visualize and protect the previously placed rhinostomies. Trauma to bone or mucosa in the area of the rhinostomy has the potential to cause scarring and obstruction to the previously created intranasal lacrimal drainage system. This could cause a return of symptoms of epiphora. The sinus surgeon should be aware of a history of lacrimal surgery and realize that in endonasal approaches, there will be no external scar to mark the presence of previous surgery.

Joseph P. Mirante, MD, FACS; Dewey A. Christmas, MD; Eiji Yanagisawa, MD, FACS

References

(1.) Mercandetti M, Mirante JP. Powered endonasal dacryocystorhinostomy. In: Krouse JH, Christmas DA, eds. Powered Endoscopic Sinus Surgery. Baltimore: Williams & Wilkins; 1997:137-44.

(2.) Mercandetti M, Mirante JP. Endoscopic dacryocystorhinostomy. Facial Plast Surg Clin North Am 1997;5(2):195-202.

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Title Annotation:RHINOSCOPIC CLINIC
Author:Mirante, Joseph P.; Christmas, Dewey A.; Yanagisawa, Eiji
Publication:Ear, Nose and Throat Journal
Article Type:Clinical report
Geographic Code:1USA
Date:Feb 1, 2010
Words:382
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