From the Guidelines
The endonasal dacryocystorhinostomy (DCR) procedure involves several key steps, including administration of topical anesthesia and insertion of a 0-degree endoscope to visualize the nasal cavity 1.
Key Steps:
- The procedure begins with the creation of a mucosal flap using a Freer elevator, and the exposure and opening of the lacrimal sac with a Kerrison rongeur 1.
- The nasal mucosa and lacrimal sac mucosa are then anastomosed using a 6-0 Vicryl suture.
- Some studies suggest the use of Mitomycin C to minimize the amount of corresponding raw surfaces and increase patency rates 1.
- Postoperative stenting is not recommended due to its association with a high failure rate and stimulation of granulation formation, which can lead to restenosis 1.
- Instead, postoperative dilations for up to one year may be used to maintain patency and achieve a stable result 1.
Post-Operative Care:
- Patients are typically prescribed a 7-day course of oral antibiotics, such as ciprofloxacin 250mg twice daily, and topical nasal decongestants, including oxymetazoline 0.05% twice daily for 3 days.
- The use of mucosal flaps and Mitomycin C can help minimize the risk of complications and improve outcomes 1.
From the Research
Steps for Endonasal Dacryocystorhinostomy (DCR) Procedure
The steps for an Endonasal (endoscopic nasal) Dacryocystorhinostomy (DCR) procedure can be summarized as follows:
- Creation of a fistula from the lacrimal sac into the nasal cavity via a bony osteotomy 2
- Removal of nasal mucosa, bone, and lacrimal sac mucosa sequentially 2
- Preservation of the nasal and lacrimal mucosa, and bringing them into contact during the procedure 3
- Creation of posteriorly hinged lacrimal sac and nasal mucosal flaps 3
- Manual osteotomy of the frontal process of the maxilla and removal of the lacrimal bone 3
- Trimming and repositioning of the mucosal flap to cover exposed bone around the newly created nasolacrimal fistula 4
- Use of mechanical or powered approaches, with or without mucosal flaps, with no significant difference in outcomes 5
Surgical Techniques
Different surgical techniques have been proposed for Endonasal DCR, including:
- Mechanical (Mecn-END-DCR) and powered (Pow-END-DCR) approaches 5
- Preservation of mucosal flaps, which may not be essential for a superior outcome 5
- Use of endoscopic control, which allows for a less traumatic and efficacious procedure 6
Indications and Results
Endonasal DCR is indicated for patients with lachrymal system obstruction, and has been shown to be effective in relieving symptoms of epiphora and improving lacrimal sac patency 2, 3, 4, 6