|
|
ARTICLE |
|
Year : 1958 | Volume
: 6
| Issue : 4 | Page : 78-79 |
|
Dacryocystorhinostomy - Observation on 52 cases
SP Srivastava
Department of Ophthalmology, Gandhi Medical College, Bhopal, India
Date of Web Publication | 8-May-2008 |
Correspondence Address: S P Srivastava Department of Ophthalmology, Gandhi Medical College, Bhopal India
Source of Support: None, Conflict of Interest: None | Check |
How to cite this article: Srivastava S P. Dacryocystorhinostomy - Observation on 52 cases. Indian J Ophthalmol 1958;6:78-9 |
More and more surgeons are taking up dacryocystorhinostomy as the operation of choice for chronic dacryocystitis. With simple techniques and improved instruments it is no more a tedious and troublesome operation and in efficient hands has given very encouraging results.
The author has been tempted to report this small series of 52 cases of dacryocystorhinostomy because of the unexpectedly good results obtained with the present technique. Only one out of 52 cases operated failed.
Material | | |
The 52 cases operated consisted of 38 females and 14 males, thus showing a significant difference in the sex incidence. The youngest patient was of 14 years and the oldest 62 years of age.
Out of these 52 cases 39 were cases of simple chronic dacryocystitis with lacrimation and mucopurulent discharge on pressing over the sac region. Five complained of simple epiphora in whom syringing revealed an obstruction of the naso-lacrymal dust. Five cases were of atonic mucocele and three of chronic dacryocystitis with fistula. The duration of symptoms varied from 3 months to 6 years.
Operative Technique | | |
Pre-operative medication : 38 cases received sodium amytal 3 grains on the previous night and again half an hour before operation. In 14 cases Largectil 20-25 mgs, and Pethedine 100 mgs were given intra-muscularly half an hour before the operation.
Anaesthesia : The nasal cavity on the appropriate side is packed with ribbon gauze soaked with 2% Anethaline solution and adrenaline hydrochlor (1:1000). A local infiltration anesthesia with 2% novocain and adrenaline was used in all cases. It is important to hit off the infraorbital and trochlear nerves, so that the operation area is not too much infiltrated which otherwise would make the dissection and identification difficult.
Operation : The incision, exposure of lacrymal sac and medial bony wall is done along the lines described by Jain, Sethi and Om Prakash (1955) The differences in the steps of the operation from this point onwards are as follows :
For retracting the sac and other lateral structures the author uses an evisceration scoop the broad blade of which with its concavity to the lateral side acts as a good retractor and at the same time protects the sac from injury while making the bony window.
With the help of a sharp chisel and hammer a bony window 1.5 cm x 1 cm. is cut in the same way as described by Jain et al (1955). Any irregularities in the window are corrected with the help of a punch forceps.
A distinct change in the sound on hammering indicates that the bone is cut through and is a signal to stop further hammering lest the nasal mucous membrane is damaged.
Incision : We are in full confirmity with Hallum (1943) and Jain, Sethi and Om Prakash (1955) in making the incision 7-10 mm medial to the inner canthus, which should be brought down to the bone in one sweep. In no case of ours was the angular vein cut. In most of the cases it is not quite necessary to cut the medial palpebral ligament.
It is useful to detach the nasal mucous membrane from the bone by passing a rugine through the anterior cut before levering away the excised bone. This saves the mucous membrane from injury.
In some cases ethmoidal cells may be opened, in which case any portion of ethmoidal labyrinth which obstructs easy access to the nasal mucosa may be confidently removed.
Without removing the nasal plug, the mucous membrane is cut vertically with a single straight cut and not converted into an 1 by two small cuts perpendicular to it at the two extremitis. The cut is made more anteriorly so as to make a broader posterior flap which facilitates stitching.
The use of Dupuy-Dutemps needle for stitching of the flaps is much easier than the technique described by Jain et al (1955).
Post Operative Treatment | | |
Procaine penicillin 4 lac units is given for 4-5 days. The first dressing is done after forty-eight hours and then daily. The stitches are removed after 6 to 8 days. First syringing is done on the 5th or 6th day and then on alternate days for a week, then every week. The cases were followed up from three weeks to a few months.
Results | | |
Out of the fifty-two cases operated with the present technique only one case has failed. Results with the period of follow up to date are shown in [Table - 1].
Summary | | |
1. A series of 52 cases of dacryocystorhinostomy is presented. Differences in technique from that described by Jain et al (1955) are described in brief with comments bearing out the important points.
2. It is claimed that with the above technique the operation of dacryocystorhinostomy becomes simple, quick and effective.[3]
References | | |
1. | Jain, Sethi, and Om Prakash (1955) Journal of All India Ophth. Soc. 3, 37. |
2. | Hallum A. V. (1943) Trans. Med. Assn. Georgia, 32, 186. |
3. | Hallum A. V. (1948) Trans. amer. Med. Ophthal, Soc. 46, 243. |
[Table - 1]
|