conjunctival sac nasal anastomosis

Applicable to the tear duct, the nasolacrimal duct is completely occluded. Treating diseases: nasal foreign bodies Indication Tears and nasolacrimal ducts were completely occluded. Preoperative preparation Prepare a leather piece with a width of 5 to 6 mm and a length of 50 mm. Surgical procedure 1. On the nasal side of the inner 5 mm, the skin incision began at 5 mm above the medial malleolus, parallel to the anterior tear, and curved slightly to the temporal side. It is about 20mm long and reaches the full thickness of the skin. The periosteum is separated and the internal hemorrhoids are cut if necessary. A 10 mm × 12 mm bone window was made in the wall of the lacrimal sac, and a mucosal flap with a base upward, 8 to 10 mm in length and 5 mm in width was made on the nasal mucosa. 2. A conjunctival flap with a base in the nasal conjunctiva, 10 mm long and 6 mm wide, straight to the medial malleolus. 3. Using a sharp blade to make a tunnel under the conjunctival flap of the tear lake to the periosteum of the lacrimal sac, the inner mouth is level with the upper edge of the bone window. 4. The nasal mucosa flap was pulled through the tunnel to the tear lake, and the mucosa was externally sutured to the conjunctival wound, 4 mm from the limbus. 5. Pull the conjunctival flap through the tunnel to the lacrimal sac, and place a rubber strip in the new path between the nasal conjunctiva and the nasal mucosa between the nasal cavity and the tear lake. 6. Pull the conjunctival flap back to the lacrimal sac and sew it to the leading edge of the nasal mucosa. 7. On the nasal side of the inner 5 mm, 5 mm above the medial malleolus began to make a skin incision, parallel to the front of the tears, slightly curved to the temporal side of the curve. It is about 20mm long and reaches the full thickness of the skin. 8. Separate the subcutaneous tissue and muscles, place the lacrimal sac opener, and expose the anterior tear and sac. Cut the periosteum before the anterior tear. Do not guilty. 9. Use a small periosteal separator to push the periosteum to the sides. Divide the nose first and push it open about 4mm. 10. Separate the periosteum of the lacrimal sac and the lacrimal wall. The periosteal separator should be placed against the bone wall. Back to the tears, squat up, up to the top of the lacrimal sac, down to the nasolacrimal duct. 11. The bone-building window is located in the front lower part of the lacrimal sac, as low as possible, and the front is more than 2 mm beyond the front of the tear. First, use a curved tube clamp to break the bone wall in the lower part of the lacrimal sac and form a small hole with a diameter of about 3 mm. Use a small rongeur to extend into the bone hole and cut it back and forth, and expand into an oval hole with a size of 10 mm. ×12mm to prevent biting the nasal mucosa. 12. Insert the lacrimal duct probe from the lacrimal canal and eject the side wall of the lacrimal sac. A transverse incision was made in the apex of the lacrimal sac nasal wall with a blade, and another parallel incision was made as low as possible in the lacrimal sac. 13. Make a vertical incision between the two transverse incisions of the lacrimal sac to make the incision "i" shaped. And make a corresponding "i" shaped incision on the nasal mucosa 14. Using a 3-0 nylon thread, suture the internal hemorrhoids with a u-shaped suture, suture the periosteum and the rest of the tear fascia. 15. Suture the muscles and skin according to the dacryocystorhinostomy. Single dress bandage, single eye light pressure bandage. The epidural catheter with a small tear is exposed and applied to the skin of the eyebrow with a tape. complication When the nasal mucosal flap is too short, the conjunctival defect is too large, and the outer superior conjunctival flap can be used to make up the foot.