endoscopic dcr - maximizing success dr zeeshan ahmad nmch patna
TRANSCRIPT
Dr Zeeshan Ahmad
M.S.(ENT, PGY3)
Department of ENT, NMCH, Patna.29.01.2015
DCR
Opthalmologist -----------> Otolaryngologist
Big responsibility for ENT to give ~100% result
For 100% result – proper case selection
These features ensure success :-
Epiphora duration <1 year
No history of pus or abscess
Prefer female patient
Able to do nasal douching
Can come for follow up regularly
No Opthalmic comorbidities
These features ensure success :-
Regurgitation test positive
Hard stop on probing
Distended sac
Syringing yields mucoid material slowly
DNS to the opposite side
Can do all the cases
But caution is required in following :-
Gross DNS to Operative side
Revision case
Case with suppuration
Common canalicular block
Steroid - if too inflamed
Regular preop syringing
Antibiotics oral/topical
Control nasal allergy
Bone removal – bone removal – bone removal
Expose upto - sac fundus
Incise after tenting with lacrimal probe
Fashion the sac like a book
Tuck the sac beneath nasal mucosa
Achieve hemostasis without packing
Use stent in revision cases
DCR has moved from the hands of opthalmologists to the Otolaryngologist
not just because it has scar advantage
but it is also more physiological and
epistaxis is better controlled.
Our series - 14 cases – 2 failures
one due to CC block and other due to inefficient bone removal.
05.02.15 Dr Sonu Kr SinghM.S.(ENT,PGY3)
Juvenile Nasopharyngeal
Angiofibroma – origin,
spread, management