|Year : 1969 | Volume
| Issue : 5 | Page : 226-228
PN Nagpal, RN Mathur, CR Baldha
M. P. Shah Medical College, Jamnagar, India
P N Nagpal
M. P. Shah Medical College, Jamnagar
|How to cite this article:|
Nagpal P N, Mathur R N, Baldha C R. Drill dacryocystorhinostomy. Indian J Ophthalmol 1969;17:226-8
From the time of Toti (1904) external dacryo-cystorhinostomy has gradually become a more popular operation for dacryocystitis. This, when done properly gives the greatest chance of success. However time and again transcanalicular approaches have been recommended. (Bedrossian 1965, 1967, Jack, 1963) which appear to be much simpler and almost amount to office treatment. But this procedure is not yet quite popular.
We have devised a rhinostomy drill which can be passed through the canaliculus to make a clean rhinostomy. The whole procedure is very simple and takes a few minutes. We wish to share this experience with a review of 18 cases of transcanalicular dacryocystorhinostomy operations performed in the department of ophthalmology at M. P. Shah Medical College, Jamnagar.
| Material & Methods|| |
Rhinostomy Drill:-We have prepared locally a spiral drill [Figure - 1] which resembles in shape any dental burr or root canal files and this can be fitted into the hand piece of a dental engine. Its diameter is equal to a size 4 Bowman probe. A lacriminal canula made out of a No. 16 injection needle is used as a protector [Figure - 2] for soft tissues and through which this drill passes freely [Figure - 3].
Operative procedure : - All cases were operated under local anesthesia. The conjunctival sac was anaesthetised by 4 % Xylocaine drops. The nose was packed with a nasal pack soaked in xylocaine 4%, with ephedrine. The region of the sac and adjacent bone was infilterated with 2% xylocaine. The lower or upper punctum and canaliculus were dilated gradually to a number 7 Bowman lacrimal probe. The lacrimal canula was inserted through the canaliculus into the lower part of the sac. The rhinostomy drill was now connected to the hand piece of dental engine and inserted through the canalicular protector [Figure - 4] into the sac. The engine was turned on and 5-7 holes were made adjacent to each other in the lower medial wall of the sac into the middle meatus. The canalicular protector was now withdrawn with the drill and the nasal pack removed.
The opening was cleaned with a lacrimal probe and irrigated. In some cases a diathermy coagulation of the margins of the holes was done by inserting the thinnest diathermy electrode through the canalicular protector using a current of about 35-50 mA. The eye was bandaged for a day after putting antibiotic ointment. A daily syringing was done for 3 days with penicillin solution repeated once a fortnight for three months.
| Observations and Results|| |
The age incidence of 18 cases (3 males and 15 females) subjected to drill rhinostomy is shown in [Table - 1]. The youngest patient was 12 years of age and the oldest was 66 yrs. 16 cases were of chronic dacryocystitis, one had chronic dacryocystitis with fistula and one was acute dacryocystitis rendered quiescent. There was no difficulty in operation in any of them.
Results : 14 of these 18 cases (78%) the rhinostomy was functioning for more than three months. In four cases, the openings became blocked and external rhinostomy was performed in three cases. There was no difficulty in the operation after the transcanalicular drilling. At the time of operation fibrosis was seen.
| Comments|| |
Bedrossion (1965, 1967) and Jack (1963) used transcanalicular route for rhinostomy. Bedrossian used 16 veirs trocar to make rhinostomy and used polyethylene tube for three months to keep it patent and reported success in 8 of his 13 cases (61%). Jack used a drill to make the opening and left a stainless steel wire in place for three months. In our experience with this technique rhinostomy remained patent in 780% cases.
This operation though very much successful in our series is not a "cure all" for all cases of dacryo-cystitis but we recommend it because of its simplicity, no external scar and good rate of success. In unsuccessful cases external rhinostomy would always be possible without any problem.
| Summary|| |
A transcanalicular approach to rhinostomy by a specially designed drill is presented. In 14 of the 18 cases the rhinostomy remained patent for more than three months. In three unsuccessful cases external rhinostomy was performed successfully without any difficulty.
Acknowledgements :-We are thankful to Dr. S. K. Mehra, M.D.S., Lecturer in Dentistry, for all his help. We are also thankful to Shri Rashikbhai and Shri D. R. Jadeja for making the drill and secretarial help respectively.
| References|| |
|1.||Bedrossian R. H.: Office dacryocystorhinostomy, Arch. Ophthal (Chicago) 73; 356-358 (1965). |
|2.||Idem; (1967) A simplied approach to Lacrimal Drainage System Problems; Inter. Surgery, 48; 41-4ffi5. |
|3.||Jack M. K. Dacryocystorhinostomy. Am. J. Ophthal; 56; 979-977 (1963). |
|4.||Toil A. Clin med pisa 10. 385. (1904) |
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]
[Table - 1]