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Juan Carlos Chaparro Morante, MDHospital Nacional Arzobispo Loayza

Clínica InternacionalUNMSM

Email: jcchm65@hotmail.comPhone: 511 999946091Webside: www.endocirugianasal.blogspot.com

Objective. Report our experience and surgical treatment of the unilateral giant dacryocele using the endoscopic technique.

Method. Case report. We present the case of an adult patient with chronic dacryocystitis of 1 year of evolution, treated by endoscopic endonasal surgery (endoscopic dacryocystorhinostomy). The CT described a giant mucocele of the right lacrimal sac. The technique was whole by endoscopic way, opening the lacrimal bone.

Results. This patient was followed endoscopically each week, testing the permeability of the fistula, moving the probe and checking the opening hole during 6 months after surgery. There were no recurrences neither any complications.

Conclusion. The endoscopic dacryocystorhinostomy has became a very safe method to resolve lacrimal sac pathologies, as well as being reliable, secure and with less sequelae as presented in the external dacryocystorhinostomies.

Endoscopic surgical management of dacryoceleEndoscopic surgical management of dacryoceleJuan C. Chaparro Morante, MD1,2,3; Mónica Hidalgo Venegas, MD1,2,4; Víctor Valdivia Calderón, MD1,2,3; Ángel Chaparro Morante, MD1; Jorge Heredia Ch.1

1Universidad Nacional Mayor de San Marcos Lima – Perú, 2 Clínica Internacional, 3Hospital Nacional Arzobispo Loayza, 4Essalud

The endoscopic dacryocystorhinostomy has became a very safe method to resolve lacrimal sac pathologies, as well as being reliable, secure and with less sequelae as presented in the external dacryocystorhinostomies.

Case report of a 38 years old man, that descripcs the evolution of the patology of the lacrimal sac. We present the case of an adult patient with chronic dacryocystitis of 1 year of evolution, treated by endoscopic endonasal surgery (endoscopic dacryocystorhinostomy) in July 2012 at the Arzobispo Loayza National Hospital, Lima – Peru.

The lacrimal excretory system is prone to infection and inflammation for several reasons. The mucosa of the lacrimonasal tract has two ends: the conjunctiva and nasal mucosa, that normally is colonized with bacteria. The lacrimal excretory system drains tears from the eye into the nasal cavity. The stagnation of tears of a pathologically closed lacrimal drainage can result in dacryocystitis.

Dacryocystitis can be acute or chronic. The acute dacryocystitis presents painful and red of the ocular canthus. In the chronic dacryocystitis there is a permanent obstruction of nasolacrimal duct, with constant tearing, tumor and pain.The congenital dacryocystitis is a special form of chronic dacryocystitis, which occurs when the nasolacrimal ducts do not develop properly.

The objectives were to report our experience and surgical treatment of the unilateral giant dacryocele using the endoscopic technique. Improve the lacrimal sac treatment with endonasal surgery, thus avoiding external dacryocystorhinostomy and its sequelae.

INTRODUCTIONINTRODUCTION

METHODS AND MATERIALSMETHODS AND MATERIALS

1. Fontenla J. R., Ortiz S. Tratamiento del paciente con dacriocistitis. JANO 2007;23 (1) 39 – 41.

2. Stanley E. Thawley, MD. The Otolaryngologist–Ophthalmologist Relationship: An Historic Perspective. Otolaryngol Clin N Am.. 39 (2009) 845–853.

3. Martínez Ruiz-Coello A, Arellano B. Results of 12 years of endoscopic dacryocystorhinostomy. Acta Otorrinolaringol Esp. 2011, Jan-Feb; 62(1):20-4.

4. Wormald PJ. Evaluación de los resultados de la dacriocistorrinostomía endoscópica potenciada. Laryngoscope 112:69-71, 2007.

5. Demarco R, Strose A Endoscopic revision of external dacryocystorhinostomy. Otolaryngol Head Neck Surg. 2007 Sep;137(3):497-9.

6. Walker RA, Al-Ghoul A, Conlon MR. Comparison of nonlaser nonendoscopic endonasal dacryocystorhinostomy with external dacryocystorhinostomy. Can J Ophthalmol. 2011 Apr;46(2):191-5.

7. Milojević M, Avramović S, Endoscopic dacryocystorhinostomy. Vojnosanit Pregl. 2010 Jun;67(6):463-7.

8. Oghan F, Ozcura F. A novel stenting technique in endoscopic dacryocystorhinostomy. Eur Arch Otorhinolaryngol. 2008 Aug;265(8):911-5. Epub 2008 Feb 2.

9. Knijnik D. Analyzing endoscopic dacryocystorhinostomy: difficulties and solutions.Arq Bras Oftalmol. 2007 May-Jun;70(3):391-4.

10. Ben Simon GJ, Joseph J. External versus endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction in a tertiary referral center. Ophthalmology. 2005 Aug;112(8):1463-8.

CONCLUSIONSCONCLUSIONS

ABSTRACTABSTRACT

CONTACTCONTACT

This patient was about one year with tearing, pain an continuos lacrimal infections. The patient was evaluated by several ophthalmologists, who finally decided the surgery by the endoscopical technique by the otolaryngologist.

The CT described a giant mucocele of the right lacrimal sac. The technique was whole by endoscopic way, opening the lacrimal bone, the lacrimal sac with mucosal content, using finally a silicone probe. It was placed nasal packing for 3 days and was carried out endoscopic control.

RESULTSRESULTS

This patient was followed endoscopically each week, testing the permeability of the fistula, moving the probe and checking the opening hole during 6 months after surgery. There were no recurrences neither any complications

Figure 1. Patient before surgery Figure 2. Coronal CT before surgery Figure 3. Axial CT before surgery

Figure 4. Opening of the giant mucocele Figure 5. Silicone tubes in situ Figure 6. During the surgery