A novel stenting technique in endoscopic dacryocystorhinostomy

Abstract

The objective of our study was to evaluate in a prospective noncomparative case series, the clinical efficacy and the results of modified T-tube insertion instead of silicone tube in endoscopic dacryocystorhinostomy (EDCR). Following ophthalmologic examinations, 22 patients (16 female, 6 male) suffering from recurrent chronic epiphora with postsaccal stenosis for whom DCR was indicated, underwent EDCR at Dumlupinar University Hospital by an otorhinolaryngologist and an ophthalmologist between the years 2006 and 2007. Instead of inserting a classic silicone tube passed through canaliculi and knotted inside the nose, a modified T-tube was used, without passing it through punctum, and was placed to stoma with a less traumatic endonasal endoscopic technique. The medial wall of the sac was incised vertically and the T-tube was placed horizontal to the incision. Postoperatively, the patients were evaluated by endoscopic controls in the first, third, sixth, and twelfth months to evaluate T-tube localization and rhinostomy opening site. The success was defined as resolution of epiphora with patent ostium after evaluation by irrigation and nasal endoscopy. Eighteen patients (82%) showed complete resolution of epiphora at 12-months of follow-up. Re-stenosis was observed only in four cases, one in the sixth and the other in the ninth postoperative months. Granulation tissue formation near the rhinostomy site was seen in one patient, which did not cause any functional problem. The success rate was calculated as 82%. We conclude that modified T-tube placement in EDCR seems to be a practical and less traumatic technique. This is also a cheaper method besides being less traumatic and easier to perform than canalicular stenting. It can be considered as a useful alternative to the classic silicon tubes in cases of epiphora resulting from the postsaccal stenosis.