Flap suturing endonasal dacryocystorhinostomy assisted by ultrasonic bone aspirator

Abstract

Background

In the external dacryocystorhinostomy (DCR), a sutured anastomosis technique performed between the nasal mucosal and lacrimal sac flaps reported by Dupuy-Dutemps and Bourguet was the gold standard and was believed to lead to the success of the surgery. However, because of the small working space, a flap suturing technique has not been completely established in endonasal DCR (END-DCR).

Objectives

The effect of the modified flap suture anastomosis technique using a Sonopet ultrasonic bone aspirator was retrospectively compared to that using a diamond burr in patients with nasolacrimal duct obstruction.

Materials and Methods

One hundred ten patients underwent the modified flap suturing technique using the Sonopet, and 30 patients were operated on using a diamond burr.

Results

Successful patency of the lacrimal ostium (LO) was obtained in all patients in both groups. The rates of successful suturing during the operation and of a large diameter of the LO 3 months after the operation were significantly higher in patients in whom the Sonopet rather than the burr was used.

Conclusions and Significance

The Sonopet might offer similar surgical outcome to the traditional microdrill DCR and is a safer means of bone removal in END-DCR in the small working space.

Chinese Abstract

背景：Dupuy-Dutemps 和 Bourguet 报道了鼻粘膜和泪囊瓣之间的缝合吻合技术是外泪囊鼻腔吻合术 (DCR) 的金标准。该技术被认为是手术成功的原因。然而, 由于操作空间小, DCR (END-DCR)手术的鼻内皮瓣缝合技术尚未完全确立。

目的：回顾性比较了使用 Sonopet 超声骨吸引器改进的皮瓣缝合吻合技术与使用金刚石钻孔器对于鼻泪管阻塞患者的效果。

材料与方法：采用Sonopet改进的皮瓣缝合技术对100 例患者进行了手术；采用金刚石钻孔器对40名患者进行了手术。

结果：两组患者均取得了泪道口（LO）的成功通畅。术中缝合成功率及术后 3 个月大直径 LO 的比率在使用 Sonopet 的患者中比使用金刚石钻孔器的患者明显更高。

结论和意义：Sonopet 可能提供与传统微钻 DCR方法相似的手术结果, 是END-DCR 手术的狭小操作空间内更安全的去骨方法。

Keywords:

• Dacryocystorhinostomy
• endonasal
• ultrasonic bone aspirator
• lacrimal sac
• nasal mucosa
• double flap
• suture

Acknowledgments

The authors express our sincere appreciation to all members of the Department of Otolaryngology and Ophthalmology, University of Toyama, for their assistance and cooperation.

Disclosure statement

The authors declare no conflicts of interest in association with the present study. The authors alone are responsible for the content and writing of the paper.