Abstract
Background: The occlusion of the lacrimal stoma by granulation tissue or synechiae is the most common cause of surgical failure in Endonasal Endoscopic Dacryocystorhinostomy (EEDCR), several lacrimal and nasal mucosal flaps for stoma reconstruction were created, with the goal of reducing peristomal granulation tissue and thereby stomal stenosis.
Aim of the work: To see how effective flapless techniques in EEDCR and maintained nasal and lacrimal mucosal flaps are at reducing stomal stenosis in EEDCR.
Patients and methods: Thirty patients with primary acquired nasolacrimal duct obstruction (PANLDO) were divided into two groups: Group (A): included 15 patients who underwent EEDCR with preserved posteriorly based mucosal flap and Group (B): included 15 patients who underwent EEDCR with removal of the nasal mucosal flap. The occurrences of granulation tissue, synechiae and success rate of EEDCR were compared.
Results: The overall success rate of EEDCR was 93.3% (14/15) for group ( A) and 86.7% (13/15) for group (B) (P = 0.543) with no statistically significant difference. Granulation tissue at the ostium borders was seen in 6.7 % (1/15) of the cases in group A and % (3/15) of the cases in group B (P = 0.283), Synechiae were seen in 13.3% (2/15) of group A patients compared to 20% (3/15) of group B patients (P = 0.624).
Conclusion: The adoption of a posteriorly based nasal mucosal flap will cover bare bone of ostuim and reduce granulation tissue, scar tissue and ostium closure, and increase the EEDCR success rate.