Endoscopic Endonasal DCR with Silicon Stenting

Abstract

Introduction: Endoscopic DCR is preferred for its scar less, minimally invasive technique. Many modifications including placement of silicon stents has been done over the years to reduce the recurrence. Endonasal endoscopic and External DCR approaches have their own advantages and disadvantages. Endoscopic DCR is one of the several techniques to unblock the nasolacrimal duct.Aims : To Study the surgical outcomes of Endoscopic Endonasal Dacryocystorhinostomy (DCR) technique with and without the use of silicon stent intra operatively.Materials and methods: This was a retrospective, observational and comparative study to compare the results of ENDODCR with stent and without stent.. The study group consisted of 40 patients of both sex and above 20 years of age with having symptoms and signs suggestive of nasolacrimal duct blockage. All the cases and controls were randomly selected and included as the study groups. For each case one control was selected by matching the age, sex, symptoms and signs of nasolacrimal duct blockage.Results: Out of 40 patients 12 patients had associated intranasal pathology corrected. Out of 12 patients 7(17.5%) patients had septoplasty and 5 (12.5%) patients had FESS surgery done simultaneously along with endoscopic DCR. On the 1st follow up visit at 1st week all 20(100%) patients in group B (endo DCR without stenting) had patency on syringing The association between relief of symptoms and Endoscopic DCR with stent at 6th month was highly significant statically (p<0.01). Objective analysis after 6 month showed patency of nasolacrimal duct among Group A patients after endo DCR with stent was higher than the Group B patients with Endo DCR without Stent, which was statistically significant.(p<0.01). Subjective assessment for relief of symptoms at 6 months among Group A patients after endo DCR with stent was statistically (p<0.01)higher (95%) than among the Group B patients with endo DCR without stent (75%). Endoscopic endonasal DCR 34 (85%) cases were successful and only 6 (15%) cases were failure.Conclusion: Endoscopic DCR is a safe, cast effective alternative for external DCR in patients with nasolacrimal duct obstruction. We found that endoscopic DCR with stent had several advantages over more conventional external approach.