Conditions for improving the effectiveness of surgical treatment of patients with chronic dacryocystitis in endonasal endoscopic procedures

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Abstract


Introduction. Surgical treatment of patients with chronic dacryocystitis is a complex interdisciplinary problem. Lacrimal sac can be reached externally and internally (endonasally). The effectiveness of the treatment largely depends on the results of complete diagnosis and choice of a treatment method.

Purpose. To analyze the effectiveness of surgical treatment of patients with chronic dacryocystitis in endonasal access.

Materials and methods. The study of 225 patients consisted in the analysis of two groups of patients (2015–2019) with chronic dacryocystitis: the first group (110 patients) underwent an endonasal endoscopic dacryocystorhinostomy in the form of monooperation, the second underwent endonasal endoscopic dacryocystorhinostomy with additional intranasal interventions (115 patients). All patients underwent endoscopic examination of the nasal cavity and midface multispiral computed tomography (MSCT).

Results. The results of the obtained data convincingly showed a higher efficiency of treatment in the group of patients with combined operations with the pathological processes revealed in intranasal localization in comparison with the group of monoperations.

Conclusion. According to the study data, patients with chronic dacryocystitis should undergo full ophthalmologic and endonasal diagnostics, including multispiral computed tomography-dacryocystorhinography of the middle facial zone according to the described algorithm. When detecting pathological processes hindering the standard endonasal endoscopic dacryocystorhinostomy, it is necessary to perform an expanded scope of surgical interventions which will contribute to the efficiency of treatment of patients with chronic dacryocystitis up to 91.3%.


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About the authors

Dmitriy V. Davydov

Peoples’ Friendship University of Russia

Author for correspondence.
Email: davydov3@yandex.ru

Russian Federation, Moscow

MD, PhD, DMedSc, Professor, Head of Department, Reconstructive Surgery Department with Ophthalmology Course

Мagomed М. Маgomedov

N.I. Pirogov Russian National Research Medical University

Email: magalor62@mail.ru

Russian Federation, Moscow

Professor of the Department of Otorhinolaryngology

Napisat М. Маgomedova

European Medical Center

Email: Nmagomedova91@mail.ru

Russian Federation, Moscow

Nmagomedova91@mail.ru

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Supplementary files

Supplementary Files Action
1.
Fig. 1. Endoscopy of the nasal cavity. Endoscope 4 mm 0°. The lacrimal tubercle covers the area of projection of the lacrimal sac

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2.
Fig. 2. Endoscopy of the nasal cavity. Endoscope 4 mm 0°. The enlarged concha bullosa obstructs access to the operating field

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3.
Fig. 3. Endoscopy of the nasal cavity. Endoscope 4 mm 0°. Pronounced septal crest and vasomotor rhinitis

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4.
Fig. 4. MSCT – dacryocystorhinography. Ectasia of the lacrimal sac. Deviation of the nasal septum

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5.
Fig. 5. Patient G., 64 years old. Multispiral dacryocystorhinography: a – on the right, the contrast agent fills the lacrimal sac. Deviation of the nasal septum. Difficult nasal breathing; b – 6 months after. After endoscopic endonasal dacryocystorhinostomy with correction of the nasal septum and thermal destruction of the inferior turbinate. On the right, a bone window is visualized on the lateral wall in the area of the lacrimal sac projection. The tear passes freely. Free nasal breathing

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6.
Fig. 6. Concomitant pathological processes in the nasal cavity in the examined patients

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7.
Fig. 7. Patient K., 38 years old. Endoscopy of the nasal cavity. Granulation in the area of dacryorhinostomy 1 month after endoscopic endonasal dacryocystorhinostomy

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8.
Fig. 8. Endoscopy of the nasal cavity. 2 months after endoscopic endonasal dacryocystorhinostomy (group I). Synechiae in the region of the anterior end of the middle turbinate. Curvature of the nasal septum

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Copyright (c) 2020 Davydov D.V., Маgomedov М.М., Маgomedova N.М.

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