Endoscopic Septoplasty & Mucosal preservation Conchoplasty in a failed case of DCR

This video demonstrates Mucosal preservation endoscopic turbinlasty for concha bullosa. It is a simple and effective technique for conchal resection where the function of the middle turbinate is preserved. It enables easy access to the maxillary line and allows identification of the proposed site of neo-ostium in the endoscopic dacryocystorhinostomy. Endoscopic dacryocystorhinostomy (DCR) is a standard lacrimal procedure. It is not uncommon to encounter anatomical variations during an endoscopic dacryocystorhinostomy that must be addressed simultaneously with endoscopic DCR for ease of surgery and better outcomes. Additional adjunctive procedures such as septoplasty and middle turbinoplasty aim to improve access to the lateral nasal wall1. The deviated nasal septum is not uncommon, and if it prevents a clear view of the axilla of the middle turbinate should be addressed.

Sometimes it may be possible to complete endoscopic sinus surgery or endoscopic DCR despite a deviated nasal septum by decongesting it or giving a contralateral push over the septum. This septal deviation returns at the end of surgery and may cause synechiae to obstruct the neo-ostium. Moreover, operating in a crowded field may lead to mucosal lacerations, synechiae and failure of DCR surgery.

Another commonly seen condition is concha bullosa. Concha bullosa is the pneumatization of the middle turbinate. It is a common anatomic variant of the middle turbinate and is best diagnosed on a CT scan. The incidence of concha bullosa varies from 8 to 53%.1 Radical resection of the turbinate may lead to severe functional disturbances leading to secondary atrophic rhinitis. The “empty nose” syndrome results in disturbed climatization and interferes with pulmonary function1.

Conchoplasty in endoscopic dacryocystorhinostomy is needed when the concha blocks access to the lacrimal sac area.