|Year : 1967 | Volume
| Issue : 3 | Page : 100-101
One flap dacryocystorhinostomy with intubation
VN Prasad, GS Katara
Department of Ophthalmology, G.S.V.M. Medical College, Kanpur, India
|Date of Web Publication||21-Jan-2008|
V N Prasad
Department of Ophthalmology, G.S.V.M. Medical College, Kanpur
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Prasad V N, Katara G S. One flap dacryocystorhinostomy with intubation. Indian J Ophthalmol 1967;15:100-1
We present here an easy technique of doing dacryocystorhinostomy which has been done at G.S.V.M. Medical College, Kanpur in twenty cases.
| Operative Technique|| |
Pre - Operation preparation : - A through nasal examination is done to exclude any pathology leading to its contraindication. Patients 15 years., or more are chosen to avoid general anasthesia and are given 100 mg of pethidine intramuscularly just 15 minutes before operation. The operation is done under local anaesthesia for lacrymal sac. The nasal cavity is packed with a solution of 2% Anethane with adrenaline.
We have already described in this Journal the technique of taking and stitching the anterior flaps only. Prasad (1966).
| Operation|| |
The lacrymal sac and fossa are exposed by the usual method. A bony opening of 15 x 12 mm with rounded edge is prepared in the lacrymal fossa. The lower border of the opening should be upto the upper end of the naso lacrymal duct.
An incision is made in the nasal mucosa along the posterior border of the opening in the lacrymal bone, and then extending the two limits of the incision anteriorly. Thus one big anterior flap is formed. In the same way a big anterior flap in the sac is prepared. The lower incision in the sac extends from the naso lacrymal duct to the upper limit of the fundus of the sac.
Finally the two ends of the incision are extended anteriorly to make a big anterior flap.
A polythene tube 5 mm in diameter and about 10 inches in length is taken and is passed through the nose till it reaches to lacrymal fossa. It is pulled up into the cavity of the sac and this end of the tube is anchored to the adjacent tissue in the sac area by plain catgut. The nasal end of the tube is anchored to the aloe nasi by a silk thread.
The two anterior flaps are stitched with 00000 catgut. If the flaps are too big then they are anchored to the surrounding tissue as they may sag and block the anastomosis. Finally the wound is closed after dusting crystaline penicillin powder in the wound. The remaining portion of the polythene tube is fixed to the face by a adhesive plaster. An antibiotic ointment and dressing are applied.
The stitches are removed on the 7th day when the polythene tube is also taken out. On this post operative day syringing of the sac is done. For two weeks twice a week the sac is syringed. Then syringing is done once a week for one and half months.
| Observation|| |
All the selected cases were over 15 years of age. The patency was finally evaluated by syringing the passage three month after the operation.
With this procedure in 95% of cases, patency of the passage was achieved and maintained.
| Discussion|| |
Various modifications have been adopted by different surgeons to overcome the two stumbling blocks in dacryocystorhinostomy: (1) Stitching of the flaps and (2) maintaining the patency of the artificial opening.
We present here a note on our modification of the technique which seeks to overcome both these difficulties.
This is a simple technique and less time consuming. In younger age groups a general anaesthesia is needed. Previously we have reported on forty five cases of dacryocystitis with one flap dacryocystorhinostomy without intubation. In that series syringing had to be done all the time to keep the ansestomosis clear. Addition of intubation as a step in the operation technique prevents oozing of blood from the nasal mucosa, reduces thus clot formation and promotes bridging between the posterior flaps, thus leading to greater success of operation.
| Summary|| |
Twenty cases of dacryocystorhinostomy were performed by stitching only the anterior flaps of the lacrymal sac and the nasal mucosa. The success of this technique in 95% in this series is attributed to the additional step of leaving a polythene tube drain from the sac into the nasal cavity.
| References|| |
Prasad, V. N. (1966), J. All. India Ophthal. Soc. 14, 176-177.