Endoscopic Dacryocystorhinostomy in Post traumatic Lacrimal drainage system obstruction

  • Nishi Gupta

Your browser needs to be JavaScript capable to view this video

Try reloading this page, or reviewing your browser settings

You're watching a preview of subscription content. Log in to check access

This video presents the trauma to the lacrimal sac. The nasolacrimal duct (NLD) includes severe lacerations of the lacrimal sac and Le Fort II and Le Fort III type nasoethmoid fractures1,2,3,4 following high impact blunt trauma. Since the upper lacrimal pathway is protected by the medial canthal ligament and lacrimal obstruction usually occurs in the bony nasolacrimal canal2. It further adds to the difficulty if it involves a lacrimal sac with its entrapment in the fractured segment.

Management of traumatic lacrimal drainage pathway obstruction remains challenging, unlike primarily acquired NLD obstruction. The anatomy of the bony lacrimal fossa and NLD is altered with a lot of scarring, and the surgery carries an increased risk of failure2. Some studies prefer external DCR and Dacryocystectomy in cases where flap formation is complex. They discourage endoscopic, endonasal, or laser DCR in posttraumatic NLD obstruction due to the loss of bony anatomical landmarks after trauma and subsequent surgery2.

The current video describes that a successful endoscopic DCR is possible even in the most complex posttraumatic obstructions of the lacrimal pathway. A step-wise approach to these cases with a careful reading of the preoperative DCG and complete marsupialization of the portion of the sac above the common canaliculus gives an excellent long-term outcome.

The patient had a fractured frontal process of the maxilla with its posteromedial impaction into the ethmoids. The sac was lacerated and divided into fragments. Preoperative CT DCG provided valuable information. CT DCG showed a breach in the bone covering the superior part of the sac that allowed prolapse of skin and muscle with the prominent segment of the fundus of the sac hidden under it. All aspects of the sac were exposed and marsupialized. Intraoperative assessment and Preoperative CT/CT DCG helped in achieving an excellent outcome in these complex cases.

Introduction

This video demonstrates successful endoscopic management of a very complex case of posttraumatic dacryocystitis.

About The Author

Nishi Gupta

Dr. Nishi Gupta is currently the head of the Otorhinolaryngology and associate medical director at Dr. Shroff’s Charity Eye and ENT hospital New Delhi India. Her initial work on Endoscopic Dacryocystorhinostomy was compiled and was released by Dr. Shroff’s Charity Eye & ENT hospital in the form of a video cassette in 1999. She subsequently published three editions on Endoscopic dacryocystorhinostomy, first in 2006, second in 2011, and third in 2020 with Springer. She has published articles in various national and international journals and has reviewed national and three international journals.

Dr. Gupta obtained her MS degree in Otorhinolaryngology from Nagpur university in 1992, followed by a Postgraduate diploma in hospital management from NIHFW Delhi and training at Great Ormond Street Hospital for Children London. She popularized the technique of endoscopic dacryocystorhinostomy in the country. For more than two decades, her association with the only Eye & ENT institute helped her pursue her passion in endoscopic lacrimal sinus and orbital surgeries. She has been conducting annual live surgical demonstration workshops and hands-on cadaver dissection training sessions on endoscopic dacryocystorhinostomy and endoscopic sinus surgeries for more than two decades.

 

About this video

Author(s)
Nishi Gupta
DOI
https://doi.org/10.1007/978-981-19-4615-8
Online ISBN
978-981-19-4615-8
Total duration
13 min
Publisher
Springer, Singapore
Copyright information
© Producer, under exclusive license to Springer Nature Singapore Pte Ltd. 2022

Related content

Video Transcript

[MUSIC PLAYING]

Hello. My name is Nisha Gupta, and I’m working as Deputy Medical Director and Head Department of Otorhinolaryngology at Dr. Shroff’s Charity Eye and ENT Hospital, New Delhi, India. This is a video on Endoscopic Dacryocystorhinostomy in Post Traumatic Lacrimal Drainage System Obstruction.

Patients of post-traumatic lacrimal drainage disorder present with a variety of facial deformities, like a crooked nose due to fracture of the frontal process of maxilla, prominent facial scar, and saddle nose due to nasal bridge collapse and telecanthus. Endoscopic DCR in a post-traumatic case is often challenging due to multiple fractures of the floor of the orbit and lateral wall with a compressed maxilla, as we can see in this case, fracture of the frontal process of maxilla, and multiple plate fixation. All these cases have callus formation and need extensive drilling.