Samarapuri A, Kavitha K
BACKGROUND The success rate of endonasal dacryocystorhinostomy with the modified flap technique is almost equivalent to that of external dacryocystorhinostomy. In the initial period, the nasal mucosal flap was excised in endoscopic endonasal dacryocystorhinostomy and the ridge of the bony ostium is left uncovered. This leads to outgrowth of the bony ostium which is the commonest cause for failure in endonasal dacryocystorhinostomy. In our modified technique, we have covered the bony ridge with nasal mucosal flap to prevent bony outgrowth and closure of the ostium. The study was performed to evaluate the improvement in success rate following modified mucosal flap technique in endoscopic endonasal dacryocystorhinostomy (DCR). MATERIALS AND METHODS A prospective study was conducted on 28 patients in the age group of 20-60 years with distal nasolacrimal duct obstruction from January 2018-November 2018 at Chengalpattu Government Medical College Hospital. Investigations were done to rule out bleeding disorders. Diagnostic nasal endoscopy was done to look for deviated nasal septum, atrophic rhinitis and middle turbinate hypertrophy. Hypertensive patients were excluded. Endonasal dacryocystorhinostomy was done under infiltrative anaesthesia after nasal packing. A curvilinear incision was made from the attachment of middle turbinate to the attachment of inferior turbinate. The bony ostium was made and after lifting up the mucosa, the sac was opened anteriorly, medial wall being excised anteriorly. In the modified mucosal flap technique, splitting of the nasal mucosa into two halves to cover the trimmed bony edge was done. RESULTS In our study, females were most commonly affected and the common age group being 31-50 years. Success rate with modified mucosal flap technique was 92.86% as compared to the conventional mucosal flap technique (89.9%). We had failure rate of 7.14% due to synechiae formation. Distal stenosis from progressive healing and closure of the ostium was the common cause of failure in conventional mucosal flap technique. CONCLUSION Modified mucosal flap technique with splitting of the nasal mucosa into two halves to cover the trimmed bony edge has shown to improve the success rate in our study.
