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Clinical Note |

Endonasal Endoscopic Dacryocystorhinostomy in Children

Michael J. Cunningham, MD; John J. Woog, MD
Arch Otolaryngol Head Neck Surg. 1998;124(3):328-333. doi:10.1001/archotol.124.3.328.
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Objective  To describe the indications, technique, and results of endonasal endoscopic dacryocystorhinostomy in children with congenital and acquired disorders of the nasolacrimal system.

Design  Retrospective case series.

Setting  Tertiary care hospital.

Patients  Four children ranging in age from 10 months to 6 years.

Intervention  Primary or revision endonasal endoscopic dacryocystorhinostomy performed via a joint otolaryngologic-ophthalmologic team approach.

Main Outcome Measures  Incidence of surgical complications and postoperative clinical status.

Results  The duration of follow-up was 10 to 24 months with a successful clinical outcome in all 4 children. Two procedures were complicated by nasal vestibule skin abrasions secondary to rotation of the drill shaft.

Conclusions  Despite the technical challenges posed by the small anatomical dimensions of the pediatric nasal airway, the combination of proper otolaryngologic endoscopic instrumentation and ophthalmologic lacrimal sac transillumination guidance allows for the safe and successful performance of endonasal endoscopic dacryocystorhinostomy in the pediatric population.

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Figure 1.

Contrast-enhanced axial computed tomographic scan demonstrates a cystic enlargement of the nasolacrimal sac with lateral protrusion into the medial canthal region (arrowheads).

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Figure 2.

Coronal computed tomographic scans document partial opacification of the right maxillary and ethmoid sinuses (A), osseous defect (arrows) in the anterior ethmoid-lacrimal bone (B), and a circumscribed fluid density (arrowhead) in the medial canthal region in both images.

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Figure 3.

The surgical technique of endonasal endoscopic dacryocystorhinostomy. A, A rigid fiberoptic light probe is passed via the superior or inferior punctum into the lacrimal sac. B, The rhinostomy portion of the operation requires removal of both nasal mucosa and lacrimal bone under light probe guidance. C, Tenting of the lacrimal sac wall with the light probe or a standard lacrimal probe facilitates performance of the dacryocystotomy. D, A bicanalicular silicone intubation of the surgically created nasolacrimal fistula completes the procedure.

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