David M Chan1, Iuri Golubev2, Taha Z Shipchandler3, William R Nunery4, H B Harold Lee4. 1. Department of Otolaryngology Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, IN. 2. Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN. 3. Department of Otolaryngology Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, IN. Electronic address: tshipcha@iupui.edu. 4. Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN; Oculofacial Plastic and Orbital Surgery, Indianapolis, IN.
Abstract
PURPOSE: External dacryocystorhinostomy (EXT-DCR) is the gold standard in the treatment of acquired nasolacrimal duct obstruction. Intranasal pathology can compromise the success of primary and revision external dacryocystorhinostomy EXT-DCR procedures. Nasal septal deviations resulting in unfavorable anatomy are an identified cause of DCR failures. In this study, we examine the causes of failure in our patient population and propose that concomitant treatment of septal deviations at the time of primary EXT-DCR can decrease the rate of revision surgery. MATERIALS AND METHODS: Retrospective review of patients who had undergone an EXT-DCR. RESULTS: Over a five year period, 12 EXT-DCR failures were identified and 8 were directly attributable to nasal septal deviations. Revision surgery was successful in all 8 cases after correction of the nasal septal deviation. A second cohort of patients was identified who had undergone primary EXT-DCR and septoplasty concomitantly. Eight consecutive patients underwent the combined procedure for a total of 10 EXT-DCR and 8 septoplasties. The only failure was due to a common canalicular obstruction (90% success rate for the combined approach). CONCLUSIONS: As a result of our findings, we believe that treating nasal septal deviation at the time of the initial surgery can help minimize the need for revision surgery.
PURPOSE:External dacryocystorhinostomy (EXT-DCR) is the gold standard in the treatment of acquired nasolacrimal duct obstruction. Intranasal pathology can compromise the success of primary and revision external dacryocystorhinostomy EXT-DCR procedures. Nasal septal deviations resulting in unfavorable anatomy are an identified cause of DCR failures. In this study, we examine the causes of failure in our patient population and propose that concomitant treatment of septal deviations at the time of primary EXT-DCR can decrease the rate of revision surgery. MATERIALS AND METHODS: Retrospective review of patients who had undergone an EXT-DCR. RESULTS: Over a five year period, 12 EXT-DCR failures were identified and 8 were directly attributable to nasal septal deviations. Revision surgery was successful in all 8 cases after correction of the nasal septal deviation. A second cohort of patients was identified who had undergone primary EXT-DCR and septoplasty concomitantly. Eight consecutive patients underwent the combined procedure for a total of 10 EXT-DCR and 8 septoplasties. The only failure was due to a common canalicular obstruction (90% success rate for the combined approach). CONCLUSIONS: As a result of our findings, we believe that treating nasal septal deviation at the time of the initial surgery can help minimize the need for revision surgery.