Iranian Journal of Pathology

External Dacryocystorhinostomy; Success Rate and Causes of Failure in Endoscopic and Pathologic Evaluations

Document Type : Original Research

Authors

Hassan Ghasemi 1
Sajedeh Asghari Asl 2
Mohammad Ebrahim Yarmohammadi 2
Farhd Jafari 2
Pupak Izadi 2

1 Dept of Ophthalmology, Medical School, Shahed University, Tehran, Iran

2 Dept of Otolaryngology, Medical School, Shahed University, Tehran, Iran

https://doi.org/10.30699/ijp.2017.24234
Abstract
Background and Objectives: External dacryocystorhinostomy (DCR) is the method of choice to treat nasolacrimal duct (NLD) obstruction and the other approaches are compared with it, with a failure rate of 4% to 13%. The current study aimed to assess the causes of failure in external DCR by postoperative endoscopic and pathological evaluation.
Methods: The current retrospective cross sectional study followed-up113 patients with external DCR and silicone intubation for three months. Silicone tubes were removed after the third months. Failure was confirmed based on the clinical findings and irrigation test. Paranasal sinus computed tomography (CT) scanning, and endoscopic and pathological evaluations were performed in the failed cases.
Results: Totally, 113 patients underwent external DCR. The patients included 71 females and 42 males. The mean age of the patients was 55.91 years; ranged from 18 to 86. Epiphora was the most common complaint before surgery (90.3%). Clinically, epiphora continued in 17 cases (15%), of which 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-value=0.00). Pathologically, there were significant relationship amongst the failure rate, scar formation, and allergic rhinitis (P-values =0.00 and <0.05, respectively).
Conclusion: Preoperative endonasal evaluation and consultation with an otolaryngologist can improve surgical outcomes and help to have a better conscious to intranasal abnormalities before external DCR surgery.

Highlights

  • Majority of patients, who had failed external dacryocystorhinostomy (DCR) surgery, have at least one sinus CT or endoscopic or pathologic abnormality.
  • These abnormalities were septal deviation, scar formation, concha bullosa, septal adhesion, enlarged middle turbinate and sump syndrome.
  • Pathologically, there were significant relationships between the failure rate and scar formation and allergic rhinitis.
  • In DCR surgery, Preoperative endonasal evaluation and consult with an otolaryngologist are highly recommended.

Keywords

Lacrimal sac
Nasolacrimal Duct
Epiphora
Dacryocystorhinostomy
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Iranian Journal of Pathology
Volume 12, Issue 3
Summer 2017
Pages 189-194

  • Receive Date 19 February 2016
  • Revise Date 12 October 2016
  • Accept Date 12 October 2016

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