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External DCR – gold standard for NLDO compared to endonasal or transcanalicular DCR Aim – consider factors affecting success of DCR Inclusion criteria.

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Presentation on theme: "External DCR – gold standard for NLDO compared to endonasal or transcanalicular DCR Aim – consider factors affecting success of DCR Inclusion criteria."— Presentation transcript:

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3 External DCR – gold standard for NLDO compared to endonasal or transcanalicular DCR Aim – consider factors affecting success of DCR Inclusion criteria – chr.dacryocystitis, mucocele, epiphora. Exclusion criteria - < 10yrs, nasal pathology, lid laxity, canalicular obstruction.

4 Lacrimal drainage disorders Chronic dacryocystitis (59) Lacrimal fistula (1) Mucocele (1) Previous failed DCR(1)

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6 Age and sex distribution malesNo. of patients <40yrs1 40yrs-85yrs6 females <40yrs15 40yrs-85yrs40 Total62

7 Surgical procedure Large osteotomy Suturing of anterior flaps Silicon tube intubation

8 Anterior Nasal Mucosal Flap

9 Sac Mucosal Flap

10 Silicon Intubation Tube

11 Silicon Tube Knotted

12 Knotted Silicon Tube Outside The External Nares

13 Nasal and Sac Mucosal Sutured

14 Silicon Intubation Tube Seen In The Puncta

15 Intraoperative complications Bleeding from incision site2 Bleeding from nasal mucosa8 Inappropriate place and size of osteotomy0 Difficulty fashioning the mucosal flaps1

16 Intraoperative bleeding % of casesstudy 27.5%Mirzaman etal 13%Adravani etal 6.2%Gazemund K 0.6%Akhund 16.2%Present study

17 Late postoperative complications scar4 Conjunctival irritation by tube2 Non patency1 Punctal/canalicular tear0

18 Post operative complications Scar very faint - acceptance complications like migration of tube, rupture of central thinner segment, slitting of punctum – not found.

19 Postoperative results patentNon patent At 6 months (silicon tube removed ) 611 At 1 year611

20 98% success Success – resolution of symptoms like epiphora and discharge & a patent lacrimal system on irrigation. Silicon intubation facilitates epithelialization of DCR fistula.

21 Success rates with silicon intubation % of successStudy conducted 97.5%Mirzaman etal 95%Tarbat etal 98.14%Talpur etal 95%Advani etal 96%Besharati MR etal 98%Present study

22 Conclusion Meticulous surgery and proper identification of structures. Big osteotomy esp, younger patients. Silicon tube intubation in all. Tight opposition of anterior flaps.

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