Atlas of Nose and Paranasal Surgeries

ATLAS OF NOSE AND PARANASAL SURGERIES 28 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 i. Lacrimal sac incision. Alternatively a sickle knife through the lacrimal canaliculi can be introduced, until sac is localized. External palpation of the lacrimal area is also a simple but effective method. Different surgical strategies to open the lacrimal sac are reported. Authors usually realize a mucosal posterior flap. The incision is made with a sickle knife. 60 until sac is localized. External palpation of the lacrimal area is also a simple but effective method. Different surgical strategies to open the lacrimal sac are reported. We usually realize a mucosal posterior flap. The incision is made with a sickle knife (Figs. 6.9 and 6.10 ). In case of chronic dacryocystitis, with recidivant infections, a purulent secretion can be visualized in this step. An aspiration with toilette and repeated lavages of this area is done. This posterior mucosal flap is just apposed to the posterior mucoperiosteal flap, precedently realized, in order to maintain open the surgical stoma (Figs. 6.11 and 6.12 ). The superior mucoperiosteal flap is then repositioned under the drilled area. The use of stents is not routinely performed, but we use these in revision surgery or in fibrotic lacrimal sac (Figs. 6.13 and 6.14 ). Hospital dismissal in first day. The antibi- otic therapy is not always recommended at home, Fig. 6.9 Lacrimal sac incision M. Trebbi et al. (continued)... ...(continued) i