|Year : 1983 | Volume
| Issue : 4 | Page : 329-330
Double-cannalicular-single tube intubation in dacryocystorhinostomy
B Pradeep, Babu Rajendran
Vijaya Hospital, Madras, India
Vijaya Hospital, Madras
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Pradeep B, Rajendran B. Double-cannalicular-single tube intubation in dacryocystorhinostomy. Indian J Ophthalmol 1983;31:329-30
|How to cite this URL:|
Pradeep B, Rajendran B. Double-cannalicular-single tube intubation in dacryocystorhinostomy. Indian J Ophthalmol [serial online] 1983 [cited 2020 Feb 23];31:329-30. Available from: http://www.ijo.in/text.asp?1983/31/4/329/27547
Dacryocystorhinostomy is the operation of choice in patients complaining of epiphora due to obstruction of the lacrimal draining system. With a success rate of over 90% in competent hands, it is surprising that it has not been accepted as a standard surgical procedure in many centres. The poor acceptance rate may be partly due to the surgical difficulty in obtaining and suturing good flaps.
This paper presents the procedure and preliminary results of a simpler surgical technique yielding comparably good results. The main advantage of this procedure is that it completely does away with all the 4 flaps which are made in conventional DCR procedures.
| Materials and methods|| |
The aim of this procedure is to obtain and maintain a patent passage from the medial wall of the lacrimal sac to the nasal cavity under the middle turbinate through a bony ossium. Previous workers have used methods of intubation using polythene, nylon and plastic tubings. With the advent of fine silicone tubing it is now possible to leave a tube in situ for several weeks without producing undue inflammation or discomfort. Fine silicone tubing used in this procedure are those produced by Dow Corning and have an outer diameter of 0.12 mm.
| Technique|| |
The anaesthesia, skin incision and exposure are carried out exactly as for a conventional DCR and a large bony ostium is made in the normal fashion.
The lateral wall of the lacrimal sac is identified, (with the help of a lacrimal probe introduced through the lower punctum if required) and this is opened to expose the cavity of the lacrimal wall. In a similar fashion the nasal mucosa covering the bony ossium is also bisected and the mucosal layer removed upto the margins of the bony ossium.
The lower cannaliculus is now dilated using progressively larger lacrimal probes until the size 2 probe passes freely through out the passage and past the medial wall of the sac. One end of an 8" piece of the silicone tube (previously autoclaved) is now threaded to a long 26 G hypodermic needle and passed through the lower cannaliculus and the medial wall of the sac. White the end of the tube is now held by an artery forceps, the indroducer is withdrawn.
The process is now repeated for the upper cannaliculus using the other end of the tube. At the end of this manouvere. A single silicone tube will traverse both cannaliculii and their free ends lie in the space between the medial sac wall and the bony ossium. A portion of the tube will lie against the globe while travelling in the inter punctal space. An artery forceps introduced through the ipsilateral nostril and into the bony ossium is now able to catch the free ends of the silicone tubes and withdraw them out of the nostril.
The most important step in the procedure is to place three knots on the silicone tube with 5/0 silk. The first knot is placed on the two arms of the tube close to the medial sac wall and is in suchaway that the tube is not too tight so as to prevent normal movements of the lid nor too loose to allow movement of the tube in the interpalpebral fissure towards the cornea.
The second knot is tied on the two arms of the tube midway between the medial sac wall and the tip of the nose and is only to prevent these two arms from seperating.
The third and final knot is again for the same purpose and is placed at the level of the external nare. Any excess tube is cut off and the skin is sutured in the usual manner. At the end of 8 weeks the interpunctal portion of the tube is cut and the free ends in the nose are pulled out.
The above procedure was used in twenty consecutive DCRs with a minimum follow up of 12 months.
The youngest patient was 10 years and the oldest was 71 years. No attempt at specific case selection was made other than an indication for DCR. Two patients in this group (the oldest and the youngest) had previous dacryocystectomy done elsewhere and had troublesome epiphora.
On an average the tubes were left in situ for 8 weeks. One patient who had bilateral DCR done by this method returned for tube removal after 16 weeks.
| Observations and discussion|| |
For sake of classifying the results, symptomatic relief of symptoms for one year was called a success. By this guideline. 17 out of the 20 cases (85%) were successful.
In one case the first knot on the tube slipped and the tube caused irritation to the eye and had to be removed after 10 days. In another case the tube was tied too tight and was cutting into the cannaliculus and had to be removed after 2 weeks in the third case the patient was involved in a fire accident in the postoperative period and had extensive facial burns involving the lids, eye and also the tube. The procedure failed to produce the desired result in these three cases,
| Summary|| |
1. A technically easier procedure to perform DCRs with comparably good results.
2. Can be tried in cases where previous DCT has been done.
3. Inspite of intubation, patient is able to return to his normal activities soon because the tube is not exposed osed and hence no cosmetic hinderance.
4. Difficulty is in obtaining silicone tube.