Nasonasal dacryocystostomy

In 1904, Toti first introduced the dacryocystorhinostomy with facial incision, which became the traditional surgery for ophthalmologists to treat chronic dacryocystitis and nasolacrimal duct obstruction. In 1921, American otolaryngologist Mosher used intranasal dacryocystorhinostomy to achieve better results. However, due to limited vision and difficulty in observation, it failed to replace the dacryocystorhinostomy with facial incision. In 1989, McDonogh underwent endoscopic intranasal dacryocystorhinostomy to overcome the difficulty of intraoperative observation, which made the procedure gradually replace the ophthalmic tradition of facial incision for dacryocystorhinostomy. Applied anatomy: The lacrimal sac is located in the lacrimal sac between the front and rear tears and is about 12 to 15 mm long. The former tears are composed of the maxillary frontal processes, and the later tears are part of the tear bones. The nasolacrimal duct runs in the bony lacrimal passage formed by the maxilla, lacrimal bone and inferior turbinate bone, and is about 18 mm long. The location of the lacrimal sac is the front end of the middle turbinate, the inner side of the nasal mound, the upper middle turbinate attachment, the front boundary is the maxillary frontal process, the posterior boundary is the uncinate process, the lower boundary is the upper edge of the inferior turbinate, and the projection of the lacrimal sac on the outer side wall of the nasal cavity. The bony inner wall of the lacrimal sac is composed of the anterior maxillary frontal process and the posterior tear bone, with a suture in the middle. Treatment of diseases: lacrimal duct obstruction Indication Nasal nasal lacrimal sac ostomy is suitable for chronic dacryocystitis, long-term tear or overflow pus, normal upper and lower punctum, and lacrimal sac angiography. Contraindications Tears caused by small tears and obstruction of the lacrimal canal. Preoperative preparation 1, according to nasal endoscopy and sinus CT scan to understand the nasal cavity, sinus with or without polyps, overflowing pus, nasal septum deviation, lower nasal obstruction, etc., to determine the surgical plan. 2, 1 day before surgery, lacrimal sac flushing. 3. Use antibiotics before surgery. If no nasal polyps, sinusitis can be used 1 day before surgery with broad-spectrum antibiotics; if nasal polyps, sinusitis must be performed simultaneously with sinus surgery, antibiotics should be used 1 week in advance, as appropriate. Surgical procedure 1. Positioning the lacrimal sac: The two leaves of the gun-shaped sputum are placed inside and outside the nasal cavity respectively, and the tip is placed inside and outside the nasal cavity respectively, and the upper and lower boundaries of the lacrimal sac are measured, and the posterior boundary is the attachment end of the uncinate process. 2. At the front end of the middle turbinate attachment, the occipital process is used as the posterior border, and a transversely-shaped portal-shaped mucoperiosteal flap is removed forward or downward or the mucosa and periosteum of the projection area of the lacrimal sac are removed. 3. Use an electric drill or a bone chisel to remove part of the bone of the frontal sinus and tear bone of the maxillary region of the lacrimal sac projection area, and open a bone window with a diameter of 1 cm to reveal the lacrimal sac wall. 4. Insert the lacrimal probe into the lacrimal sac through the small tears. The active spy is observed under the endoscope to see if it is a lacrimal sac outside the bone window. 5. Cut the lacrimal sac wall with a sickle knife or scissors. The corresponding tear wall of the bone window can be cut off, or cut into U-shaped flaps to turn down or turn over to cover the corresponding bone edge. 6. After flushing the lacrimal sac and nasal wounds, insert the silicone dilatation tube through the small tears, and lead out through the nasal cavity stoma, and fix it on the outer side wall of the nasal cavity. Alternatively, the silicone expansion tube may not be placed, and a small piece of expanded sponge (tail line) may be used to expand the lacrimal sac. 7, the surgical cavity such as hemostasis can not be filled with nasal cavity, if there is a clear bleeding can be filled with gelatin sponge, expansion sponge or oil gauze.