Dacryocystorhinostomy

Chronic dacryocystitis is a common and frequently-occurring disease in ophthalmology, which is more common in women and the elderly. Due to the ineffectiveness of drug treatment, the effect of exploration and intubation is not ideal, and the effect of laser treatment is difficult to be affirmed. At present, surgical treatment is still the main. As a classic surgical procedure, the dacryocystorhinostomy is designed to directly match the lacrimal sac with the nasal mucosa, so that the secretions and tears directly enter the middle nasal passage from the lacrimal sac to eliminate the lacrimal suppurative lesion and relieve the phenomenon of tears. Treatment of diseases: lacrimal duct obstruction chronic dacryocystitis Indication Patients with chronic dacryocystitis, lacrimal sac cyst and simple nasolacrimal duct obstruction meet the following conditions: 1. The tears and the small tubules are normal, and the flushing needle can touch the bone wall of the lacrimal sac. 2. Preoperative dacryocystography confirmed that the lacrimal sac was not significantly reduced, or a large amount of mucopurulent secretions in the lacrimal sac area were reversed from the punctum, which indirectly indicated that the volume of the lacrimal sac was not reduced, which facilitated intraoperative anastomosis. Contraindications 1. Acute inflammation of the lacrimal sac. 2. Dacryocystography shows that the lacrimal sac is very small. 3. Accompanied by nasal polyps, severe nasal septum deviation, severe suppurative sinusitis, severe atrophic rhinitis, nasal tumors and other nasal diseases. 4. Occupying lesions in the lacrimal sac, lacrimal sac tuberculosis, syphilis. 5. Old and frail, the general condition does not allow the implementation of dacryocystorhinostomy. Preoperative preparation Preoperative preparation 1. Check the nose and sinus conditions. 2. Squeeze the lacrimal sac and observe the amount of secretions. If too little, a lacrimal sac angiography should be performed. 3. Apply antibacterial eye drops before surgery. 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. 2. Separate the subcutaneous tissue and muscles, place the lacrimal sac opener, and expose the anterior tear and the internal hemorrhoids. Cut the periosteum before the anterior tear. Do not guilty. 3. Use a small periosteal separator to push the periosteum to the sides. Divide the nose first and push it open about 4mm. 4. 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. 5. 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 tears. 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. 6. 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. 7. Make a vertical incision between the two transverse incisions of the lacrimal sac to make the incision "i" shaped. A corresponding "i" shaped incision is made on the nasal mucosa. 8. Suture the lacrimal sac and the posterior flap of the nasal mucosa with a 6-0 nylon thread and suture 3 stitches intermittently. 9. Remove the cotton piece that has been blocked in the nasal cavity, and place the Vaseline gauze into the bone window with a gun. 10. Part of the gauze is pulled into the lacrimal sac. 11. Use the 5-0 silk thread or nylon thread to suture the lacrimal sac and the nasal mucosa anterior flap, and suture 3 needles intermittently. Each needle should be brought to the periosteum in front of the bone hole. To facilitate suturing, the knot can be tied together after the 3 stitches are sewn. 12. Suture the periosteum with a 3-0 nylon thread and securely sew the end of the medial malleolus to the periosteum. 13. Suture the orbicularis oculi muscle 3 to 4 needles with a 5-0 line. Then suture the skin 3 to 5 needles. 14. Single eye bandage, plus light pressure bandage. complication 1, tears rupture If you accidentally wear it, the small break can be handled. Larger perforation, repair with fine needle thread, or according to the position of the perforation, when the nasal mucosa flap is made, it is specifically matched with the lacrimal sac. 2, the tears are too small During the operation, the lacrimal sac was too small, and the lacrimal sac was made into the front page, and the nasal mucosa was also made into a larger anterior page and sutured. A drainage tube was built in the bone hole and left for 2 weeks after surgery. If the lacrimal sac has been shrunk into a strip and there is almost no cyst, it will be replaced by lacrimal sac removal or laser nasolacrimal duct recanalization. 3, postoperative bleeding More common within 48h after surgery. A small amount of temporary bleeding can make the patient rest quietly and generally do not handle it. A larger amount of bleeding can be filled with a gauze strip soaked with adrenaline and tetracaine to stop bleeding, and a hemostatic drug is added to the whole body. 4, infection Attention to preoperative and postoperative antibacterial drugs to wash the lacrimal sac and systemic antibacterial drugs, generally can avoid postoperative infection.