• Users Online: 64716
  • Home
  • Print this page
  • Email this page

   Table of Contents      
ARTICLE
Year : 1958  |  Volume : 6  |  Issue : 4  |  Page : 78-79

Dacryocystorhinostomy - Observation on 52 cases


Department of Ophthalmology, Gandhi Medical College, Bhopal, India

Date of Web Publication8-May-2008

Correspondence Address:
S P Srivastava
Department of Ophthalmology, Gandhi Medical College, Bhopal
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


Rights and PermissionsRights and Permissions

How to cite this article:
Srivastava S P. Dacryocystorhinostomy - Observation on 52 cases. Indian J Ophthalmol 1958;6:78-9

How to cite this URL:
Srivastava S P. Dacryocystorhinostomy - Observation on 52 cases. Indian J Ophthalmol [serial online] 1958 [cited 2024 Mar 28];6:78-9. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?1958/6/4/78/40708

Table 1

Click here to view
Table 1

Click here to view
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 Top


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 Top


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 Top


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 Top


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 Top


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 Top

1.
Jain, Sethi, and Om Prakash (1955) Journal of All India Ophth. Soc. 3, 37.  Back to cited text no. 1
    
2.
Hallum A. V. (1943) Trans. Med. Assn. Georgia, 32, 186.  Back to cited text no. 2
    
3.
Hallum A. V. (1948) Trans. amer. Med. Ophthal, Soc. 46, 243.  Back to cited text no. 3
    



 
 
    Tables

  [Table - 1]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Material
Operative Technique
Post Operative T...
Results
Summary
References
Article Tables

 Article Access Statistics
    Viewed1363    
    Printed57    
    Emailed0    
    PDF Downloaded0    
    Comments [Add]    

Recommend this journal