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INTRODUCTION: Flight staff are at particular risk of iterative sinus barotrauma. We here report a case of barotraumatic atelectasic frontal sinusitis with dynamic radiologic change in frontal sinus volume. CASE REPORT: A 46-year-old air pilot was referred for right frontal pain occurring at each landing. Two sinus CT scans were taken: one after a period of intense flying and the other after a month without flying. In the right frontal sinus, a type-3 Kuhn cell changed in volume from 6×11×12mm to 13×18×19mm. The alteration involved a modification in the medial wall, which was demineralized and changed position within the frontal sinus. Removal during endoscopic frontal sinusotomy allowed complete resolution of pain. DISCUSSION: This article reports radiologic change in a frontal sinus wall in a setting of repeated barotraumatic frontal sinusitis with a dynamic atelectasic component. In iterative barotrauma, we advocate imaging at different time points. When the ostial obstruction is identified, functional aeration surgery can be applied.
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PURPOSE: To compare two distinct surgical techniques in the management of chronic Primary Lacrimal Canaliculitis (PLC) with clinically detectable concretions. MATERIALS AND METHODS: Inclusion criteria: Patients presenting with symptoms consistent with the diagnosis of primary lacrimal canaliculitis (PLC) with ocular involvement were gathered. Gomori-Grocott Methenamine Silver test was used for concretion staining. Two groups were identified based on the surgical technique. Group A consisted of patients who underwent a punctum sparing canalicular curettage using a chalazion curette, while the patients in Group B underwent one-snip punctoplasty with lateral canaliculotomy. Failure was defined as recurrence of the initial symptoms at any time (ocular and canalicular inflammation with purulent discharge and pouting punctum). The results were analyzed by comparisons using a Fisher's exact test. RESULTS: Ninety-six consecutive patients (96) with a confirmed diagnosis of PLC underwent surgical treatment between 1987 and 2017. Data were collected and divided based on the surgical technique discussed above (Group A and B). Group A: 51 cases with a mean follow-up time of 22 months [1-224] presented with a mean age of 51.5 [25-83] and a surgical failure rate of 19.6%. Group B: 45 patients with a mean follow-up time of 27 months [1-176], a mean age of 68 [17-87] years and a surgical failure rate of 4.4%. Statistical significance was demonstrated, with a p-value of 0.033, odds ratio (OR) of 0.1936 and Standard Deviation (SD) at a 95% confidence interval of [0.0195-0.9885]. CONCLUSIONS: One-snip punctoplasty with lateral canaliculotomy is a simple, fast and effective procedure that allows better anatomical visualization intraoperatively and is thus shown to be statistically superior to punctum sparing canalicular curettage using a chalazion curette.
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Canaliculitis , Aparato Lagrimal , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Canaliculitis/cirugía , Enfermedad Crónica , Legrado , Ojo , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Adulto JovenRESUMEN
STUDY OBJECTIVE: To study the performance of a pre-loaded Monoka stent in the management of congenital nasolacrimal duct obstruction (CNLDO). STUDY DESIGN: Non-randomized study of consecutive cases. MATERIALS AND METHODS: A preloaded classic Monoka silicone stent contained entirely inside its introducer (Lacrijet) was used to treat a consecutive series of subjects with CNLDO over an 11-month period (May 2019-March 2020). Only subjects with chronic symptomatic CNLDO were included. Subjects with intermittent tearing, canalicular pathology, trisomy 21, facial cleft, or history of lacrimal surgery were excluded. Intraoperative findings were recorded, including the degree and location of the nasolacrimal obstruction, successful metal to metal contact with the probe, any difficulties encountered by the Lacrijet device itself, procedure duration, tolerability of the fixation punctal plug, and finally, inspection of the stent after withdrawal of the inserter. Functional success was defined as disappearance of all symptoms of epiphora. RESULTS: A total of 45 preloaded Monoka Lacrijet stents (Lcj) were placed consecutively in 38 children. The mean age was 27.9 months (12-78 months). The mean procedural duration was 2.8minutes (range: 1-10min). The overall success with disappearance of all symptoms of epiphora was 88.8% (40/45). Surgery in cases of simple mucosal stenosis was successful in 92.2% (35/38) of cases, with a mean follow-up time of 7.9 months (range: 1 to 12 months). The duration of stent intubation was for this group was 32 days (range: 1-103). The surgical outcomes for the other 7 cases with more complex intraoperative findings are summarized in the publication. All withdrawn probes were intact. CONCLUSIONS: The Lacrijet stent system is a simple and reliable pushed intubation device for CNLDO in appropriately selected cases where bony stenosis of the canal is minimal.
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Dacriocistorrinostomía , Aparato Lagrimal , Obstrucción del Conducto Lagrimal , Conducto Nasolagrimal , Niño , Preescolar , Humanos , Lactante , Intubación , Obstrucción del Conducto Lagrimal/terapia , Conducto Nasolagrimal/cirugía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: The objective of this study was to confirm that the standardized endonasal dacryocystorhinostomy (DCR) technique routinely performed in adults can be used in children. MATERIALS AND METHODS: A consecutive series of children undergoing endonasal DCR between 2003 and 2017 was analysed. The surgical procedure consisted of: preoperative CT scan, anatomical localization of the ideal surgical zone, access to the nasal cavity via an optional planned enlargement, creation of a mucoperiosteal flap, osteotomy with rongeurs and equatorial resection of the medial wall of the lacrimal sac. This pediatric series was compared to a series of adult patients operated according to the same standardized technique. RESULTS: A total of 20 DCRs (17 patients, with a mean age of 8 years (range: 4-16)) were included. Anatomical localization was effective in 100% of cases without the need for transillumination. With a mean follow-up of 4 years, the success rate was 95%, and no major complications were observed. Comparison with the same surgical technique in adults revealed similar results. DISCUSSION: Our experience suggests that standardized endonasal DCR can be adapted to the nasal cavities of children. Anatomical localization is effective. The physiologically narrow nasal cavity does not constitute a major obstacle with the use of slightly smaller instruments. The results and complications are similar to those observed in adults. CONCLUSION: The same standardized endoscopic endonasal DCR surgical technique can be used in adults and children with a similar good success rate.
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Dacriocistorrinostomía/métodos , Dacriocistorrinostomía/normas , Endoscopía/métodos , Endoscopía/normas , Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Cavidad Nasal/cirugía , Conducto Nasolagrimal/cirugía , Estándares de Referencia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
STUDY OBJECTIVE: To study the intraoperative deployment of a pre-loaded probe for a "pushed" monocanalicular nasolacrimal intubation. STUDY DESIGN: Non-randomized study of consecutive cases. MATERIALS AND METHODS: Description: A classical Monoka™ silicone stent with the silicone tube attached at right angles to the punctal plug is contained entirely inside an introducer connected to a piston. Insertion: The procedure begins with intubation of the nasolacrimal duct with the metallic introducer. Traction on the piston retracts the metallic introducer inside the handpiece. This relative shortening progressively ejects the stent, starting with its free end at the bottom of the introducer. The operation was observed endoscopically under single-blind conditions. RESULTS: Twenty-eight preloaded Monoka™ stents were placed consecutively, in 28 congenital nasolacrimal duct intubations in 22 patients (28 sides). Endoscopic examination showed that the free part of the stent was progressively ejected from the introducer during retraction of the piston. Insertion of this pushed stent into the nasal cavity was effective in 23/28 cases (82.1%). A total of 28 preloaded stent insertions were attempted and 23 were correctly deployed. DIFFICULTIES ENCOUNTERED: At the end of nasolacrimal duct intubation, contact between the punctal plug and the lacrimal punctum was problematic in four cases (4/28=14.2%). At the beginning of stent placement, premature ejection of the punctal plug within the end of the introducer occurred in five cases (5/28=17.8%). These five stents failed to insert properly into the nasal cavity. At the end of insertion, retention of the punctal plug in the introducer occurred in two cases (2/28=7.1%). COMPLICATIONS: No cases of intraoperative or postoperative epistaxis were observed. CONCLUSIONS: Intraoperative nasal endoscopy validated the concept of the preloaded Monoka stent and its deployment. Reproducibility and improved reliability may require a change in stenting technique and a design modification.
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Dacriocistorrinostomía , Intubación/métodos , Obstrucción del Conducto Lagrimal/congénito , Implantación de Prótesis/métodos , Stents , Niño , Preescolar , Dacriocistorrinostomía/instrumentación , Dacriocistorrinostomía/métodos , Endoscopía/métodos , Femenino , Humanos , Lactante , Periodo Intraoperatorio , Intubación/efectos adversos , Aparato Lagrimal/cirugía , Obstrucción del Conducto Lagrimal/patología , Obstrucción del Conducto Lagrimal/terapia , Masculino , Cavidad Nasal , Conducto Nasolagrimal/cirugía , Proyectos Piloto , Complicaciones Posoperatorias/etiología , Implantación de Prótesis/efectos adversosRESUMEN
BACKGROUND: Tearing and conjunctivitis in children are commonly due to lacrimal drainage system obstruction. Congenital nasolacrimal obstruction is a common pathology treated by probing with or without silicone stent insertion, depending upon the age of the child. The silicone stent is self-retaining and placed for at least one month. Masterka® is a recent version of Monoka®, which may lead to the same surgical complications, such as intralacrimal migration. SUBJECTS AND METHODS: The medical records of two patients surgically treated with the Masterka® probe for nasolacrimal duct obstruction, who developed intralacrimal migration of the stent, were retrospectively reviewed and analyzed. A 41-month-old child and an 18-month-old child presented with disappearance of the silicone tube after 7 days and 2 years respectively. In the first case, the tube migrated completely within the lacrimal system and became externalized through the nose at 2 years, while in the second case, the Masterka® was retrieved through a canalicular approach. In both cases, infants had no further tearing. DISCUSSION: The frequency self-retaining stent disappearance is estimated at 15%. Among these cases, intralacrimal migration is only reported in 0.5% of cases. To prevent intralacrimal migration, the surgical technique must follow a certain number of rules. Management, based on residual epiphora, is discussed. CONCLUSION: Prevention of intralacrimal migration of self-retaining stents involves a rigorous analysis of the relationship between the meatus and the fixation head at the time of placement. After lacrimal intubation, scheduled monitoring is necessary to screen for stent disappearance. Management is based on clinical findings, anterior rhinoscopy and even exploratory canaliculotomy.
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Migración de Cuerpo Extraño/etiología , Aparato Lagrimal , Stents/efectos adversos , Preescolar , Dacriocistorrinostomía , Migración de Cuerpo Extraño/cirugía , Humanos , Lactante , Aparato Lagrimal/cirugía , Obstrucción del Conducto Lagrimal/congénito , Obstrucción del Conducto Lagrimal/etiología , Cavidad Nasal , Conducto Nasolagrimal/anomalías , Conducto Nasolagrimal/cirugíaAsunto(s)
Dacriocistorrinostomía , Obstrucción del Conducto Lagrimal , Conducto Nasolagrimal , Humanos , Intubación , Obstrucción del Conducto Lagrimal/diagnóstico , Longevidad , Conducto Nasolagrimal/cirugía , Elastómeros de Silicona , Siliconas , Stents/efectos adversos , Resultado del TratamientoRESUMEN
INTRODUCTION: The formation of a fistula between the lacrimal sac and the skin is a classic outcome of resistant lacrimal sac abscesses. There is currently no consensus about treatment in such cases. The goal of this study was to describe the natural history of acquired fistulas between the lacrimal sac and the skin, occurring before planned endonasal dacryocystorhinostomy (DCR) and without any treatment of the fistula. MATERIALS AND METHODS: This prospective study was only descriptive and included patients between 1999 and 2012. The patients included were adults with a nasolacrimal duct (NLD) obstruction that was planned to be treated with endonasal DCR. A resistant lacrimal sac abscess appeared a few days before the planned surgery, and fistulized spontaneously despite medical treatment. The surgery was not delayed. The DCR was endoscopic. Nothing was done for the fistula. Its healing was spontaneous. The exclusion criteria were the following: congenital fistulas, post-traumatic and/or iatrogenic fistulas, fistulas which had regressed by the day of the surgery, postoperative follow-up less than 5 months, post-traumatic and/or iatrogenic fistulas, any history of previous DCR or any other lacrimal surgery, children. RESULTS: Twenty adults (25 cases) were included in the analysis. Mean age was 79 years old (from 41 to 90). The mean follow-up was 41 months (from 5 to 108 months). The fistula spontaneously disappeared in all cases, less than one month after it had appeared and in a permanent fashion. No unsightly scar developed. DISCUSSION: Spontaneously acquired fistulas between the lacrimal sac and the skin may occur in the natural course of abscessed acute dacryocystitis. Our study showed spontaneous healing of the fistula post-endoscopic DCR. CONCLUSION: Fistula excision in fistulous acute dacryocystitis does not seem essential to its healing. The laisser-faire approach appears adequate for aesthetic outcomes as well as for functional outcomes of DCR.
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Fístula Cutánea/etiología , Fístula Cutánea/terapia , Dacriocistitis/cirugía , Dacriocistorrinostomía , Enfermedades del Aparato Lagrimal/etiología , Enfermedades del Aparato Lagrimal/terapia , Absceso/complicaciones , Absceso/patología , Absceso/terapia , Adulto , Anciano , Anciano de 80 o más Años , Fístula Cutánea/patología , Dacriocistitis/complicaciones , Dacriocistorrinostomía/rehabilitación , Progresión de la Enfermedad , Infecciones Bacterianas del Ojo/complicaciones , Infecciones Bacterianas del Ojo/patología , Infecciones Bacterianas del Ojo/terapia , Femenino , Humanos , Enfermedades del Aparato Lagrimal/patología , Masculino , Persona de Mediana Edad , Conducto Nasolagrimal/cirugía , Estudios Retrospectivos , Espera VigilanteRESUMEN
A persistent, symptomatic lacrimal duct stenosis is treated by dacryocystorhinostomy (DCR), with external (EX) or endonasal (EN) access. The basic indication is the same in all cases and either route can be used. The EX route seems better in terms of speed of surgery, learning curve and cost. It is logical to use the external route to treat the disorder when it is associated with a lacrimal sac diverticulum, an irreducible stenosis of the union canal, or a canthopexy. The EN route has been shown to be worth consideration whenever there is a nasal sinus disorder that can be repaired at the same time. Moreover, it is indicated in a rare case of lacrimal abscess that cannot be treated medically, where the risk of scarring would contraindicate standard surgery, or when DCR is recurrent. A series of prospective randomized studies is needed to determine whether the route materially influences the outcome. Until then, it is best to have both methods available for an unbiased case-by-case decision.
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Dacriocistorrinostomía , Dacriocistorrinostomía/métodos , Dacriocistorrinostomía/efectos adversos , Humanos , Cavidad NasalAsunto(s)
Dacriocistorrinostomía , Endoscopía , Conducto Nasolagrimal/cirugía , Cornetes Nasales/cirugía , Dacriocistorrinostomía/efectos adversos , Dacriocistorrinostomía/historia , Dacriocistorrinostomía/métodos , Dacriocistorrinostomía/normas , Endoscopía/efectos adversos , Endoscopía/historia , Endoscopía/métodos , Endoscopía/normas , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Cinética , Conducto Nasolagrimal/metabolismo , Osteotomía/efectos adversos , Osteotomía/historia , Osteotomía/métodos , Osteotomía/normas , Hemorragia Posoperatoria/etiología , Hemorragia Posoperatoria/metabolismo , Hemorragia Posoperatoria/prevención & control , Factores de Tiempo , Cornetes Nasales/metabolismoRESUMEN
Aneurysmal bone cysts are vascular lesions that destroy and expand bone. We report a recently treated case of an aneurysmal cyst of the sphenoid bone. A 14-year-old girl presented with frontal headaches, bouts of nausea, and vomiting. Computed tomography and magnetic resonance imaging showed typical features of an aneurysmal bone cyst. Arterial embolization was undertaken before surgery. The endoscopic transnasal procedure used allowed the complete removal of the aneurysmal bone cyst. This use of minimally invasive surgery makes this case of interest to surgeons of the skull base and sinuses.
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Quistes Óseos Aneurismáticos/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Enfermedades de los Senos Paranasales/cirugía , Seno Esfenoidal/cirugía , Adolescente , Quistes Óseos Aneurismáticos/diagnóstico , Senos Etmoidales/diagnóstico por imagen , Senos Etmoidales/patología , Senos Etmoidales/cirugía , Femenino , Humanos , Imagen por Resonancia Magnética , Enfermedades de los Senos Paranasales/diagnóstico , Seno Esfenoidal/diagnóstico por imagen , Seno Esfenoidal/patología , Tomografía Computarizada por Rayos XRESUMEN
Endonasal dacryocystorhinostomy is technically more difficult than the classic method and apparently less rational. The nasal fossa is a variable and potentially dangerous anatomic region. The uncinate process "opens the door" to the middle meatus and covers, in almost all cases, the junction between the lacrymal bone and maxillary concha. A marker almost always found. Uncinate process resection is a natural way to access the lacrymal apparatus. Associated with transillumination of the lacrymal duct, uncinate process resection, is in our opinion, a reliable and, most importantly, reproducible method for an endonasal approach to the lacrymal sac. With resection, endonasal dacryocystorhinostomy becomes a simple, safe and rapid procedure.
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Dacriocistorrinostomía/métodos , Hueso Etmoides , Humanos , Aparato LagrimalRESUMEN
PURPOSE: To analyze the interest of protected drills to perform endoscopic endonasal DCR. MATERIAL AND METHODS: [corrected] Fifty patients suffering from chronic epiphora were operated successively. None of those patients had had prior nasal surgery. The same surgeons (BF and ER) did the surgical procedure for all the cases. The technical steps were: endoscopic visualization of the middle meatus and evaluation of the anatomic variations of the nose; identification of the lacrymal bag with a 1 mm light in the canaliculus; unciformectomy; the maxillary bone was drilled with a 3.2 mm bit (straightshot Xomed), protected and irrigated; the lacrymal bag was opened by cissors and the flap was pushed in the ethmoid and coagulated. RESULTS: The suction-irrigation system was efficient to clean the surgical site, with a good endoscopic control. The protected bit didn't damage the 4-mm optics and the septal wall mucosa, even in narrow noses. The staightshot bit (Xomed) was tough enough to drill the maxillary bone in only 68 % of the surgical cases. In 28 % the drilling was unsatisfactory and in 4 % it was inefficient. The functional results at 6 month were good in 85 %. There was no difference between normal and narrow noses. CONCLUSION: The concept of protected bits perfectly matches the endoscopic endonasal DCR. The visual comfort and security of the surgical procedure are increased. Short term results are equivalent to external DCR, but are rather inefficient and expensive.
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Dacriocistitis/cirugía , Dacriocistorrinostomía/métodos , Enfermedades del Aparato Lagrimal/cirugía , Enfermedad Crónica , Endoscopía , Humanos , Irrigación Terapéutica , Resultado del TratamientoRESUMEN
OBJECTIVE: To present a case of squamous cell carcinoma developed on a thyroglossal duct cyst in an adult patient. Modalities of treatment and prevention are discussed. PATIENT AND METHODS: A 55-year-old woman had a thyroglossal duct cyst since childhood. Surgical resection had not been performed because of parental refusal. RESULTS: Diagnosis of malignant degeneration was suggested by an increase in volume associated with cervical pain. Surgery was incomplete because of carotid artery and laryngeal involvement. Postoperative radiotherapy was given. At two years follow-up, local progression was controlled by palliative chemotherapy. DISCUSSION: For most authors, the risk of recurrent infections is the main reason for surgical resection of a thyroglossal duct cyst during childhood. The risk of malignant degeneration is generally not put forward. It is rather uncommon for carcinoma to develop on a thyroglossal duct cyst. The risk is probably underestimated because surgery is generally performed early in childhood. CONCLUSION: This observation of malignant degeneration emphasizes the importance of surgical resection of thyroglossal duct cysts during childhood. We discuss treatment in the event of malignant degeneration.
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Carcinoma de Células Escamosas/patología , Quiste Tirogloso/diagnóstico por imagen , Quiste Tirogloso/patología , Carcinoma de Células Escamosas/terapia , Arterias Carótidas/patología , Terapia Combinada , Femenino , Humanos , Laringe/patología , Persona de Mediana Edad , Invasividad Neoplásica , Dolor , Cuidados Posoperatorios , Quiste Tirogloso/terapia , Tomografía Computarizada por Rayos XRESUMEN
Hemangiomas and superficial vascular anomalies of the head and neck form what usually calls the angiomas. Many terms exist in the literature for that reason the classification of the ISSVA, admitted by most of the doctors, helps us in naming the different anomalies. The processing of this pathology needs a multidisciplinary collaboration with doctors of different specialties. The evolution of the radiological, surgical techniques of laser, and who knows, of the research, allows to hope us to cure some of the particularly dangerous anomalies like the arteriovenous malformations. We presented here the different technics used in 2001 in the management of hemangioma and superficial vascular anomalies insisting on a multidisciplinary approach.
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Hemangioma/cirugía , Neoplasias Vasculares/cirugía , Adulto , Niño , Preescolar , Cara , Femenino , Hemangioma/patología , Humanos , Lactante , Masculino , Microcirugia , Cuello , Neoplasias Vasculares/patologíaAsunto(s)
Fístula Cutánea/terapia , Dacriocistitis/terapia , Dacriocistorrinostomía/métodos , Conducto Nasolagrimal/patología , Enfermedades Cutáneas Infecciosas/terapia , Espera Vigilante , Fístula Cutánea/congénito , Fístula Cutánea/diagnóstico , Quistes/congénito , Quistes/diagnóstico , Quistes/terapia , Dacriocistitis/congénito , Dacriocistitis/diagnóstico , Endoscopía , Estudios de Seguimiento , Humanos , Recién Nacido , Enfermedades del Recién Nacido/diagnóstico , Enfermedades del Recién Nacido/terapia , Masculino , Enfermedades Cutáneas Infecciosas/complicaciones , Enfermedades Cutáneas Infecciosas/diagnósticoRESUMEN
PURPOSE: To present our experience with pushed monocanalicular nasolacrimal intubation in the management of 90 consecutive cases of nasolacrimal outflow obstruction. MATERIALS AND METHOD: This paper reports a non-randomized study of 90 consecutive cases treated with a pushed Monoka intubation system (Masterka™). A metal guide is placed inside a silicone tube rather than being attached at the distal end of the tube, as done with traditional pulled intubations. Three probe lengths are available: 30, 35, and 40 mm. SURGICAL PROCEDURE: The silicone stent was pushed into a punctum, canaliculus, and nasolacrimal duct by means of the guide. After passing through the valve of Hasner and reaching the nasal floor, the guide was then delicately withdrawn while remaining oriented along the axis of the lacrimal sac and duct. Throughout this phase, the anchoring plug was held in contact with the punctum. Three study groups were set up chronologically: group 1: endo-DCR procedures done with Masterka insertions under endoscopic observation. Group 2: Masterka insertions done with endoscopic guidance. Group 3: blind Masterka insertions without endoscopic guidance. The patients in groups 2 and 3 were selected on the information obtained by lacrimal probing. Only cases with mucosal nasolacrimal stenoses were included. All patients had surgery under general anesthesia with mechanically assisted ventilation (groups 1 and 2) or spontaneous ventilation (group 3). The anchoring plug was inserted into the punctum and vertical canaliculus, either by pulling on the probe (group 1) or using an inserting instrument. RESULTS: A total of 90 pushed Monoka intubations were done. Endoscopic examination (groups 1 and 2) demonstrated visually that the pushed intubation method was effective. In none of the 28 cases did the silicone bunch up when the guide was withdrawn. DEGREE OF DIFFICULTY: This was dependent upon proper selection for pushed Monoka intubation; the length of the probe and confirmation that there no false passage was created. The pushed intubation technique was only slightly more difficult than a simple lacrimal probing. The average operating time, excluding the anesthetic procedures, was respectively 5 min (group 2) and 4 min (group 3). COMPLICATIONS DURING SURGERY: There were no anesthetic or general problems observed in the three groups. Epistaxis was also not noted. POSTOPERATIVE COMPLICATIONS: Fifteen percent (13/90). The 13 complications noted were: two cases of canaliculitis, one intracanalicular migration, eight probes that disappeared, one keratitis, and one case of involuntary removal by the patient. DELETERIOUS SIDE EFFECTS: Tearing with the probe was in place was noted in 21.1% of the cases (19/90). This tearing disappeared as soon as the probe was removed in 50% of these cases (10/19). FUNCTIONAL RESULTS: Overall, the success rate (absence of epiphora, absence of mucous discharge) was 90% (81/90) with an average follow-up period of 19 weeks (Range, 1 day to 60 weeks). Two cases were lost to follow-up at day 1 and day 7. Group 1: 90.9% (20/22 cases; average age: 65 years, with an average follow-up period of 24 weeks). Group 2: 100% (6/6 cases; average age: 3.1 years, with an average follow-up period of 14 weeks). Group 3: 88.3% (53/60 cases excluding the two cases that were lost to follow-up; mean age: 2.3 years, with an average follow-up period of 16 weeks). CONCLUSIONS: From a technical perspective, pushed nasolacrimal intubation is much simpler than the traditional pulled types of nasolacrimal intubation. The anesthetic procedure required is the same as that for a late probing procedure, but the functional results are better. The Masterka is an alternative to simple late probing in the treatment of mucosal nasolacrimal stenoses in patients of over 12 months of age.
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Intubación/efectos adversos , Intubación/métodos , Obstrucción del Conducto Lagrimal/terapia , Conducto Nasolagrimal , Adulto , Anciano , Niño , Preescolar , Endoscopía/efectos adversos , Endoscopía/métodos , Femenino , Estudios de Seguimiento , Humanos , Lactante , Obstrucción del Conducto Lagrimal/epidemiología , Obstrucción del Conducto Lagrimal/etiología , Masculino , Fenómenos Mecánicos , Persona de Mediana Edad , Modelos Biológicos , Conducto Nasolagrimal/patología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Stents/efectos adversosRESUMEN
OBJECTIVE: To study the behavior of a "pushed" monocanalicular stent by means of nasal endoscopy. PATIENTS AND METHODS: Four children (six affected sides) with congenital nasolacrimal duct obstruction were treated with monocanalicular intubation with an anchoring plug. The children's mean age at the time of the operation was 33 months (range, 30-37 months). The procedure began with probing in order to verify (a) dacryostenosis (simple or extensive nasolacrimal duct impatency) and (b) the metal-to-metal contact in the lower nasal meatus. The stent was similar to a Monoka(TM), but the guide (a malleable stainless steel probe) is located inside the silicone stent rather than projecting from it. The silicone's total length is 40 mm and the external diameter 0.96 mm. Simultaneously, the guide acts to catheterize the nasolacrimal duct by pushing the silicone through the upper and lower parts of the outflow system. The guide is removed via a punctal approach. This mode of intubation dispenses with the nasal recovery step. Nasal endoscopy was used to monitor (a) the position of the stent in the lower nasal meatus (free or submucosal), (b) mucosal damage and bleeding, and (c) the behavior of the silicone tube during removal of the guide. RESULTS: Because of the complexity of nasolacrimal ducts, two of the six sides were treated with the classical Monoka intubation method of pulling the silicone tubing out from the nasal exit of the duct (the pull technique). The pushed intubation method was used for the four simple nasolacrimal stenoses, with no problems whatsoever. In all four cases, endoscopic examination showed (a) no submucosal tunneling (false passage), (b) no noteworthy mucosal damage, and (c) no retraction (bunch-up) of the silicone tube during the metal guide removal. No particular complications were reported during the procedure or the intubation period, which lasted an average of 3 weeks. The stents were removed in the consulting room. Tearing ceased during the 1(st) week in two cases, during the intubation period. Tearing persisted throughout the intubation period in the other two cases, but ceased during the week following stent removal. The follow-up lasted 2 months. CONCLUSIONS: The pushed procedure simplifies monocanalicular nasal intubation. Its indications remain to be determined.
Asunto(s)
Dacriocistorrinostomía , Intubación/métodos , Conducto Nasolagrimal/anomalías , Stents , Preescolar , Constricción Patológica/congénito , Constricción Patológica/cirugía , Endoscopía , Diseño de Equipo , Humanos , Intubación/instrumentación , Obstrucción del Conducto Lagrimal/congénito , Cavidad Nasal , Resultado del TratamientoRESUMEN
PURPOSE: We studied the possibility of placing a new type of monocanalicular nasal intubation under general anesthesia with spontaneous mask ventilation in congenital nasolacrimal duct obstruction. PATIENTS AND METHOD: This was a non-randomized study of consecutive cases using a monocanalicular stent called the "pushed Monoka". The benefits of anchoring with meatus fixation are similar to the original Monoka device, but the probe guide or introducer is inside the silicone tube. The external diameter of the "pushed Monoka" is 0.96 mm (versus 0.64 mm in the traditional Monoka). There are three lengths: 30, 35, and 40 mm. General anesthesia was administered by inhalation of a halogen gas using a facial mask. The technique was selected by lacrimal exploration to evaluate the extent of the stenosis (simple or complex). The location and freedom of movement of the stent into the inferior nasal meatus was tested using a second lacrimal probe. Only simple stenosis cases with positive metal-to-metal contact were included in the study. INSERTION TECHNIQUE: The introducer pushes the stent into the lacrimal duct. The introducer should be removed from the silicone sleeve very carefully by gently pulling it out, millimeter by millimeter. This action is carried out while paying careful attention to keeping the stent aligned with the major axis of the lacrimal sac. Throughout this phase, the anchoring plug should remain in contact with the lacrimal punctum. Once the introducer is completely removed, the anchoring plug is secured into the vertical canaliculus. A single-use plug inserter was used. RESULTS: Fourteen children (18 sides) with congenital nasolacrimal duct obstruction were consecutively included in the study. The pushed intubations were all performed under general anesthesia with spontaneous ventilation. The average age of the children was 26.2 months (range: 14 to 46 months). The average duration of the procedure, measured between the moment that the facial mask was put into place and the child's awakening (crying, restlessness) was 14 minutes (range: 9 to 27 minutes). The most variable parameter was the use of the venous portal. The introduction of the pushed probe itself required an average 7 minutes (range: 3 to 11 minutes). None of the children showed epistaxis. In general terms, no intraoperative or postoperative complications were noted. The "pushed Monoka" tubes were withdrawn during postoperative appointments with a mean intubation duration of 34 days (range: 1 to 59 days). Postoperative success (absence of epiphora, absence of mucous discharge) was achieved in 88% of cases (16/18 sides). The average follow-up was 8.7 weeks (range: 3 to 26 weeks). Complications and side effects were minimal. One stent was withdrawn on day 1 due to a keratitis with respect to the anchoring plug. Three stents were spontaneously lost (16%) between day 2 and day 30. Anterior rhinoscopy found none of the stents in the inferior nasal meatus. These four cases were all considered successful as there was no postoperative epiphora noted. CONCLUSIONS: Pushed nasolacrimal intubation can be safely utilized under general anesthesia with spontaneous mask ventilation. This technique appears to be a simple and safe alternative to late and very late probing in the treatment of membranous congenital nasolacrimal duct obstruction in children older than 12 months.