J Korean Ophthalmol Soc.  2008 Jun;49(6):871-877. 10.3341/jkos.2008.49.6.871.

Clinical Consideration of Uncinectomy for Endonasal Dacryocystorhinostomy

• Kim JL
• Yang JW

• KMID: 2110865
• DOI: http://doi.org/10.3341/jkos.2008.49.6.871

Abstract

PURPOSE: To evaluate the effects of uncinectomy for osteotomy method during endonasal dacryocystorhinostomy (DCR).
METHODS
This retrospective review study comprised 102 nasolacrimal duct obstruction patients that underwent endonasal dacryocystorhinostomy with uncinectomy at our hospital between 2003 and 2006. The patients were classified into two groups based on records of preoperative endoscopic examination. Group A consisted of patients who had no nasal cavity abnormality, and Group B comprised patients who had a nasal cavity abnormality but received no treatment.
RESULTS
Sixty-four patients were included in Group B. The success rates of endonasal DCR were 89.5% in Group A and 90.6% in Group B, with no statistically significant difference between the two groups (p>0.99). There were no cases of mucosal burn, orbital fat prolapse, spinal fluid leak, maxillary sinusitis, or delayed bleeding.
CONCLUSIONS
Anterior resection of the uncinate process is the most important surgical step to expose the medial aspect of the lacrimal fossa and to form the precise location of osteotomy during endonasal dacryocystorhinostomy.

Keyword

Anterior Uncinectomy; Endonasal Dacryocystorhinostomy; Nasolacrimal Duct Obstruction

MeSH Terms

Burns
Dacryocystorhinostomy
Hemorrhage
Humans
Maxillary Sinus
Maxillary Sinusitis
Nasal Cavity
Nasolacrimal Duct
Orbit
Osteotomy
Prolapse
Retrospective Studies

Figure

• 

  Figure 1. Endoscopic sequence of a typical endonasal dacryocystorhinostomy procedure, including primary resection of the anterior uncinate process. (A) Preoperative appearance of a left nasal fossa showing the uncinate process (UP) protruding under the mucosa, between the nasal ridge of the maxillary bone (MB) and the middle turbinate (MT), below the transillumination spot. (B) Resection of the anterior part of the UP, and osteotomy of the MB expose the lacrimal sac. (C) Well positioned silicone tube in the nasal cavity. (D) Right nasal fossa: the UP is located between the nasal ridge of the MB and the MT, lateral to the septum. MT is medialization by Freer's elevator. (E) Anterior part of UP is resected by Blakesley forceps. (F) Lacrimal sac is exposed. J. Preoperative appearance of a left nasal fossa : the UP is located between the nasal ridge of the MB and the MT, lateral to the septum. (G) Preoperative appearance of a right nasal fossa: the UP is located between the nasal ridge of the MB and the MT, lateral to the septum. (H) Resection of the anterior part of the UP, and osteotomy of the MB expose the lacrimal sac. (I) Resected UP bony segment. (K) Resected bone segment of UP is medialization by suction tip and lacrimal fossa is exposed. (L) Resected UP bony segment.

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  Figure 2. Prominent uncinate process. Left narrowed nasal space with septal deviation. the swelling just posterior to the lacrimal ridge could be the middle turbinate or a medially bent uncinate process.

Reference

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