Nazolakrimal kanal obstrüksiyonunun tedavisinde endonazal dakriyosistorinostomi (DSR) ve endokanaliküler diyot lazer DSR'nin karşılaştırması

Clinical Research / Klinik Araflt›rma J Med Updates 2014;4(3):87–93 doi:10.2399/jmu.2014003002 Comparison of endonasal dacryocystorhinostomy (DCR) versus endocanalicular diode laser DCR for the treatment of nasolacrimal duct obstruction Nazolakrimal kanal obstrüksiyonunun tedavisinde endonazal dakriyosistorinostomi (DSR) ve endokanaliküler diyot lazer DSR’nin karfl›laflt›rmas› Mustafa Acar1, Fatih Gören2, Demet Yaz›c›3, Güven Y›ld›r›m4, Turhan San5 1 Department of Otorhinolaryngology, Yunus Emre Government Hospital, Eskiflehir, Turkey 2 Department of Otorhinolaryngology, Sakarya Hospital, Eskiflehir, Turkey 3 Department of Otorhinolaryngology, Tarsus Government Hospital, Tarsus, Mersin, Turkey 4 Department of Otorhinolaryngology, Okmeydan› Training and Research Hospital, Istanbul, Turkey 5 Department of Otorhinolaryngology, Istanbul Medeniyet University Medical Faculty, Istanbul, Turkey Abstract Özet Objective: Dacryocystorhinostomy (DCR), the treatment for nasolacrimal duct obstruction, is generally performed endonasally. In this retrospective study, we compared the anatomical and functional success rate of endonasal DCR with endocanalicular diode laser DCR. Amaç: Nazolakrimal kanal obstrüksiyonunun tedavisi olarak dakriyosistorinostomi (DSR) genellikle endonazal yoldan gerçeklefltirilmektedir. Bu retrospektif çal›flmada endonazal DSR ile endokanaliküler diyot lazer DSR’nin anatomik ve fonksiyonel baflar› oranlar›n› karfl›laflt›rd›k. Methods: Medical records of 53 patients in endonasal DCR group (Group 1) and 47 in endocanalicular diode laser DCR group (Group 2) were analyzed for preoperative syringing and probing evaluations as well as surgical details, outcomes and complications. Results: Recurrence was observed in eight patients in Group 1 and six in Group 2. Although the recurrence rates differed between the two groups, this difference was not statistically significant (p>0.05). The complications in Group 1 included eight cases of synechia and one tube protrusion, whereas the complications in Group 2 included two cases of synechia, two tube protrusions and two punctum atrophies. The presence of allergy, concha hypertrophy and septum deviation did not significantly increase the rates of recurrence or complications (p>0.05). Bleeding and pain were observed significantly more frequently in Group 1 and the patient comfort was significantly better in Group 2 (p<0.05). Yöntem: Endonazal DSR grubunda 53 (Grup 1) ve endokanaliküler diyot lazer grubunda (Grup 2) 47 hastan›n t›bbi kay›tlar› preoperatif enjeksiyon ve prob uygulamalar›, cerrahi ayr›nt›lar, sonuçlar ve komplikasyonlar›n de¤erlendirmesi aç›s›ndan incelendi. Bulgular: Grup 1’de 8 ve Grup 2’de 6 hastada nüks gözlemlendi. ‹ki grup aras›nda nüks oranlar› farkl›l›k göstermesine karfl›n bu farkl›l›k istatistiksel aç›dan anlaml› de¤ildi (p>0.05). Grup 1’deki komplikasyonlar 8 sinefli ve 1 tüp protrüzyonu, Grup 2’de ise 2 sinefli, 2 tüp protrüzyonu ve 2 punktal atrofi olgusunu içermekteydi. Alerji, konka hipertrofisi ve septum deviasyonu nüks ve komplikasyon oranlar›n› anlaml› derecede art›rmam›flt› (p>0.05). Grup 1’de kanama ve a¤r› anlaml› derecede daha s›k gözlenmifl olmas›na ra¤men Grup 2’de hasta konforu anlaml› derecede daha iyi idi (p<0.05). Conclusion: Endocanalicular diode laser DCR was found to be a good alternative to endonasal DCR surgery thanks to better postoperative comfort, shorter healing time and less postoperative pain. Sonuç: Daha iyi postoperatif konfor, daha k›sa iyileflme süresi ve daha az postoperatif a¤r›ya neden olmas› sayesinde endokanaliküler diyot lazer DSR’nin endonazal DSR cerrahisine göre daha iyi bir alternatif oldu¤u saptanm›flt›r. Keywords: Complication, dacryocystorhinostomy, diode laser, endocanalicular, endonasal. Anahtar sözcükler: Komplikasyon, dakriyosistorinostomi, diyot lazeri, endokanaliküler, endonazal. Correspondence: Demet Yaz›c›, MD. Department of Otorhinolaryngology, Tarsus Government Hospital, ‹smetpafla Mah., Tarsus, 33440, Mersin, Turkey. e-mail: Received: June 29, 2014; Accepted: September 3, 2014 ©2014 Sürekli E¤itim ve Bilimsel Araflt›rmalar Derne¤i (SEBAD) Online available at: www.jmedupdates.org doi:10.2399/jmu.2014003002 QR code: Acar M et al. Nasolacrimal duct obstruction is frequently diagnosed in patients with a history of epiphora and discharge in the eyes. Dacryocystorhinostomy (DCR) is the treatment for nasolacrimal duct obstruction and can be performed externally or endonasally.[1] External DCR which was first described by Toti in 1904[2] is performed with a success rate of 82–99 percent.[3] Fewer complications, such as cutaneous necrosis, cerebrospinal fluid leakage, maxillary and frontal sinusitis, retrobulbar hemorrhage, transient lagophthalmos and subcutaneous emphysema have been reported with this procedure[4,5] However, this lengthy surgical procedure has many disadvantages, such as external skin incisional scarring, excessive intraoperative bleeding, disruption of the medial canthus anatomy and high morbidity associated with trauma to the anterior ethmoid, middle turbinate and nasal septum.[3,6] The endonasal approach was first attempted in 1893 by Caldwell,[2] which evolved into nasal endoscopy in the 1990s. With the development of modern nasal endoscopy, many techniques, most widely endonasal approach, have been used in endoscopic DCR.[7] The advantages of endonasal DCR are the absence of external scarring with minimal postoperative hematoma formation, shorter postoperative recovery time, preservation of the pumping action on the orbicularis oculi muscle and simultaneous correction of intranasal abnormalities that can cause surgical failure, such as the formation of synechiae between the ostium and the septum or the middle turbinate.[8,9] The disadvantages of the endonasal method are technical difficulties involved in visualizing the surgical site and achieving effective soft-tissue and bone removal, possibility of orbital perforation, multiple instrumentation inside the nose, insufficient size of the osteotomy cicatricial closure of the ostium, adhesions between the ostium and the middle turbinate, formation of synechiae between the ostium and the nasal septum, and granuloma formation within the ostium.(3,10–12] There are different techniques and instruments employed in endonasal DCR. Bone removal can be achieved using the surgical drill, diamond-blurring, rongeur, hammer-chisel, radiofrequency or laser-assisted ablation.[2] An endocanalicular multidiode laser with a 400–600 μm optical fiber, producing a wavelength of 980 nm with a power of 7–20 W was used in this study. It can ablate bone and soft tissues without causing excessive collateral damage.[13] However, controversy remains as to which method is 88 Journal of Medical Updates superior, considering that each method has advantages and disadvantages. In this study we compared the anatomical and functional success rate of endonasal DCR with endocanalicular diode laser DCR. Materials and (...truncated)