lacrimal canalicular anastomosis

Tear tube nasal anastomosis: the lacrimal sac has been removed or has shrunk, the patient requested to relieve the symptoms of tears, but the tear duct is still more than 10mm. The canaliculus can be directly anastomosed to the opposite nasal mucosa. Treatment of diseases: lacrimal passage obstruction Indication The lacrimal sac has been removed or has shrunk and the patient has requested to relieve the symptoms of tears. Preoperative preparation 1. One day before surgery, the lacrimal sac was rinsed, and antibiotic eye drops were dripped into the conjunctival sac. 2, the surface anesthesia of the punctum: deep infiltration anesthesia in the lacrimal sac area, the top of the lacrimal sac and the upper part of the nasolacrimal duct, with the removal of the lacrimal sac. The front end of the middle and middle turbinate was filled with cotton pad with 1% dicaine and 0.5% ephedrine for 10 minutes. Surgical procedure basic method: 1. According to the dacryocystorhinostomy, the skin is cut, the muscles are separated, the periosteum is cut and separated, and the bone window is made. Then, a lacrimal probe is inserted into the lacrimal canal from the punctum and is directed toward the direction of the lacrimal sac. At this time, the apex can be seen on the side wall of the original lacrimal sac. 2. Cut the part with a pair of scissors to form a small round hole. At this point, the probe is exposed from the round hole. And a mucosal flap with a base below the nasal mucosa in the bone hole, 5 mm wide and 8-10 mm long. 3. An epidural catheter is inserted in place of the lacrimal probe from the punctum, exposed from the small round hole, and extended into the nasal cavity. The nasal mucosal flap was wrapped on the epidural catheter, and the mucosa was facing inward, and 3 to 4 needles were sutured with a 5-0 silk thread (not sewed through the whole layer) to form a mucosal tube. 4. Sewing the free end of the mucosa tube with the small round hole of the lacrimal sac with 3 to 4 needles. If the suture is too much to affect the suturing, the lacrimal sac expander can be removed. 5. Finally suture the periosteum, medial malleolus, orbicularis and skin. Single eye bandaging. Apply the epidural catheter to the eyebrow with a tape. Improved method: On the nasal mucosa and the lacrimal sac periosteum, a long-axis vertical, 5 mm to 7 mm oval pores were made. An epidural catheter was inserted into each of the upper and lower tear ducts. Both catheters are inserted into the nasal cavity, and the outer end is attached to the eyebrow with a tape. complication The main complication was re-occlusion, which was considered based on the re-occlusion site.