Atlas of Nose and Paranasal Surgeries

ATLAS OF NOSE AND PARANASAL SURGERIES 29 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 j. Intraoperative view. Lacrimal sac opening. (continued)... ...(continued) of the ective en the lize a e with se of tions, s step. vages flap is l flap, open . The ioned is not vision 3 and ntibi- home, irriga- s usu- ter 15 stent but cutaneous necrosis, cerebrospinal fluid leak- Fig. 6.10 Intraoperative view. Lacrimal sac opening mucosal posterior flap. The incision is made with a sickle knife (Figs. 6.9 and 6.10 ). In case of chro ic 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, while an accurate nasal hygiene with nasal irriga- tion is important. Postoperative follow-up is usu- ally performed with endoscopic exam after 15 days and then after 2 months. In case of stent positioning, this is maintained into the nasal fossa for 2–4 months. 6.5.8 Complications The complications that can arise with DCR via an external approach include postoperative hemor- rhage in some 3 % of cases, and the cutaneous but cutaneous necrosis, cerebrospinal fluid leak- age, maxillary and frontal sinusitis, retrobulbar hemorrhage, transient lagophthalmy, and subcuta- neous emphysema have also been reported. Whether DCR via an external approach may con- tribute to the disruption of medial canthal anatomy and affect the function of the lacrimal pump is still debated [ 15 ]. In contrast, endonasal DCR may have fewer cutaneous complications and less risk of significant bleeding. The endonasal approach Fig. 6.10 Intraoperative view. Lacrimal sac opening j