Atlas of Nose and Paranasal Surgeries

ATLAS OF NOSE AND PARANASAL SURGERIES 26 Authors: M. Trebbi, F. Mattioli, D. Soloperto, M. Bettini, L. Presutti Title: Endoscopic Dacryocystorhinostomy Book: Endoscopic Surgery of the Lacrimal Drainage System DOI: 10.1007/978-3-319-20633-2_6 © Springer International Publishing Switzerland 2016 g. Lacrimal bone drilling. The bony wall removal is represented by the ascending maxillary branch and lacrimal bone. In case of rich pneumatization of agger nasi, the bone removal could interest some anterior ethmoidal cells also. This step can be conducted with drill, laser, or other instruments common to sinus surgery instruments. 59 laser were found to have patency rates of only 64 % and 70 %, respectively, in two studies. Moreover, the heat generated from bone and mucosa ablation with a YAG/KTP laser may contribute to fibrosis and stenosis and conse- quent poor results [ 14 ]. 6.5.6 Bone Drilling and Lacrimal Sac Exposure The bony wall removal is represented by the ascending maxillary branch and lacrimal bone. In case of rich pneumatization of agger nasi, the bone removal could interest also some anterior ethmoidal cells. This step can be conducted with Fig. 6.7 Lacrimal bone drilling 6 Endoscopic Dacryocystorhinostomy (continued)... ...(continued) g