Comparison of Endonasal Dcr Surgery Using Cautery and Surgical Blade Technique in Cases of Chronic Dacryocystitis
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2024
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Amaç: Epifora, gözyaşının yetersiz drenajına bağlı olarak burun boşluğuna ulaşamaması nedeniyle gözlerde sulanma ile karakterize bir klinik durumdur. Epiforanın en yaygın nedeni edinsel nazolakrimal kanal tıkanıklığıdır. Erişkinlerde strandart tedavi yöntemi olarak eksternal dakriyosistorinostomi ameliyatı uygulanmaktadır. Son yıllarda endoskopik cihazların gelişmesi ve yaygın olarak kullanılmasıyla endoskopik dakriyosistorinostomi daha sık ve güvenilir olarak uygulanmaya başlanmıştır. Bu çalışmanın amacı kronik dakriyosistite bağlı edinsel nazolakrimal kanal tıkanıklığı olan olgularda cerrahi bıçak ve koter kullanılarak yapılan endoskopik dakriyosistorinostomi sonrası nazal sineşi komplikasyonu ve başarı oranlarını karşılaştırmaktır. Gereç ve Yöntem: Göz Hastalıkları polikliniğine epifora şikayeti ile başvuran ve yapılan oftalmolojik muayene ve tetkikler sonrası kronik dakriyosistit tanısı alan ve kulak burun boğaz hastalıkları polikliniğinde yapılan endoskopik nazal muayenesinde nazal patoloji izlenmeyen 60 hasta değerlendirmeye alındı. 30 hastaya koter ile diğer 30 hastaya cerrahi bıçak ile endoskopik dakriyosistorinostomi ameliyatı yapıldı. Ameliyat sonrası 1. ve 6. ay kontrol muayeneleri yapıldı. Bulgular: Cinsiyet dağılımı açısından kadın hastalar çoğunluktaydı. Toplamda hastaların 50'si (%83,3) kadın, 10'u (%16,7) erkekti. Kadın hastaların 23'üne (%46) bıçak yöntemi, 27'sine (%54) koter yöntemi ile operasyon yapıldı. Erkek hastaların 7'sine (%70) bıçak yöntemi, 3'üne (%30) koter yöntemi ile operasyon yapıldı. Toplamda 25 (%41) hastaya sol taraftan, 30 (%50) hastaya sağ taraftan, 5 (%9) hastaya bilateral operasyon yapıldı. Bıçak yöntemi kullanılan hasta grubundaki yaş ortalaması 43,77±15,84 idi. Koter yöntemi kullanılan hasta grubundaki yaş ortalaması 38,27±12,12 idi. Hastaların minimum takip süresi 6 aydı. Hastaların yapılan 1. ay kontrollerine toplam 14 hastada (%23) nazal sineşi izlendi. Bu hastalardan 3'ü (%21,4) bıçak yöntemi ile opere edilen hastalardan oluşurken 11'i (%78,6) koter yöntemi ile opere edilen hastalardan oluşuyordu. Bu fark istatistiksel olarak anlamlı gözlenmiştir (p<0,05). Bıçak yöntemi ile opere edilen hastaların yapılan 1. ay kontrollerinde 1 (%33,3) hastada gözde sulanma şikayetleri devam ederken, 6. ayda hastaların 7'sinde (%43,8) şikayeti devam ediyordu. Koter yöntemi ile opere edilen hastaların yapılan 1. ay kontrollerinde 2 (%66,7) hastada şikayetleri devam ederken, 6. ayda hastaların 9'unda (%56,3) şikayetleri devam ediyordu. Bıçak yöntemi kullanılan hastalarda %76,6 koter yöntemi kullanılan hastalarda %70 oranında başarı sağlanmıştır. Sonuç: Çalışmamızda endoskopik dakriyosistorinostomide bıçak yöntemi koter yöntemine karşı daha az nazal sineşi komplikasyonu potansiyelinin olduğu ve her iki yöntemin başarı oranının aynı olduğunu gözlemledik. Anahtar kelimeler: Epifora, koter tekniği, bıçak tekniği, nazolakrimal kanal tıkanıklığı, endoskopik endonazal dakriyosistorinostomi, dakriyosistit.
Purpose: Epiphora is a clinical condition characterized by tearing of the eyes due to insufficient drainage of tears into the nasal cavity. The most common cause of epiphora is Acquired Nasolacrimal Duct Obstruction (ANDO). In adults, the standard treatment method is external dacryocystorhinostomy (Ex-DCR) surgery. In recent years, with the development and widespread use of endoscopic devices, endoscopic dacryocystorhinostomy (En-DCR) has been performed more frequently and reliably. The aim of this study is to compare the nasal synechia complications and success rates after endoscopic dacryocystorhinostomy performed using a surgical knife and cautery in cases with Acquired Nasolacrimal Duct Obstruction. Materials and Methods: Sixty patients who presented to the Ophthalmology clinic with complaints of epiphora, were diagnosed with chronic dacryocystitis after ophthalmological examination and tests, and had no nasal pathology detected in the endoscopic nasal examination performed at the otorhinolaryngology clinic were included in the study. Thirty patients underwent endoscopic dacryocystorhinostomy surgery with cautery and the other thirty with a surgical knife. Postoperative follow-up examinations were conducted at 1 and 6 months. Results: The majority of the patients were female. Overall, 50 (83.3%) patients were female and 10 (16.7%) were male. Among the female patients, 23 (46%) underwent surgery using the knife technique and 27 (54%) using the cautery technique. Among the male patients, 7 (70%) underwent surgery using the knife technique and 3 (30%) using the cautery technique. In total, 25 (41%) patients underwent surgery on the left side, 30 (50%) on the right side, and 5 (9%) bilaterally. The average age of patients in the knife technique group was 43.77±15.84 years, while the average age in the cautery technique group was 38.27±12.12 years. The minimum follow-up period for patients was 6 months. At the 1-month follow-up, nasal synechia was observed in 3 (21.4%) patients operated with the knife technique and in 11 (78.6%) patients operated with the cautery technique. This difference was statistically significant (p<0.05). At the 1-month follow-up of patients operated with the knife technique, symptoms persisted in 1 (33.3%) patient, whereas at the 6-month follow-up, symptoms persisted in 7 (43.8%) patients. At the 1-month follow-up of patients operated with the cautery technique, symptoms persisted in 2 (66.7%) patients, whereas at the 6-month follow-up, symptoms persisted in 9 (56.3%) patients. A success rate of 76.6% was achieved in patients who underwent the knife technique, and a success rate of 70% was achieved in patients who underwent the cautery technique. Conclusion: Our study observed that the knife technique in endoscopic dacryocystorhinostomy had a lower potential for nasal synechia complications compared to the cautery technique, and that the success rates of both techniques were the same. Keywords: Epiphora, cautery technique, knife technique, nasolacrimal duct obstruction, endoscopic endonasal dacryocystorhinostomy, dacryocystitis.
Purpose: Epiphora is a clinical condition characterized by tearing of the eyes due to insufficient drainage of tears into the nasal cavity. The most common cause of epiphora is Acquired Nasolacrimal Duct Obstruction (ANDO). In adults, the standard treatment method is external dacryocystorhinostomy (Ex-DCR) surgery. In recent years, with the development and widespread use of endoscopic devices, endoscopic dacryocystorhinostomy (En-DCR) has been performed more frequently and reliably. The aim of this study is to compare the nasal synechia complications and success rates after endoscopic dacryocystorhinostomy performed using a surgical knife and cautery in cases with Acquired Nasolacrimal Duct Obstruction. Materials and Methods: Sixty patients who presented to the Ophthalmology clinic with complaints of epiphora, were diagnosed with chronic dacryocystitis after ophthalmological examination and tests, and had no nasal pathology detected in the endoscopic nasal examination performed at the otorhinolaryngology clinic were included in the study. Thirty patients underwent endoscopic dacryocystorhinostomy surgery with cautery and the other thirty with a surgical knife. Postoperative follow-up examinations were conducted at 1 and 6 months. Results: The majority of the patients were female. Overall, 50 (83.3%) patients were female and 10 (16.7%) were male. Among the female patients, 23 (46%) underwent surgery using the knife technique and 27 (54%) using the cautery technique. Among the male patients, 7 (70%) underwent surgery using the knife technique and 3 (30%) using the cautery technique. In total, 25 (41%) patients underwent surgery on the left side, 30 (50%) on the right side, and 5 (9%) bilaterally. The average age of patients in the knife technique group was 43.77±15.84 years, while the average age in the cautery technique group was 38.27±12.12 years. The minimum follow-up period for patients was 6 months. At the 1-month follow-up, nasal synechia was observed in 3 (21.4%) patients operated with the knife technique and in 11 (78.6%) patients operated with the cautery technique. This difference was statistically significant (p<0.05). At the 1-month follow-up of patients operated with the knife technique, symptoms persisted in 1 (33.3%) patient, whereas at the 6-month follow-up, symptoms persisted in 7 (43.8%) patients. At the 1-month follow-up of patients operated with the cautery technique, symptoms persisted in 2 (66.7%) patients, whereas at the 6-month follow-up, symptoms persisted in 9 (56.3%) patients. A success rate of 76.6% was achieved in patients who underwent the knife technique, and a success rate of 70% was achieved in patients who underwent the cautery technique. Conclusion: Our study observed that the knife technique in endoscopic dacryocystorhinostomy had a lower potential for nasal synechia complications compared to the cautery technique, and that the success rates of both techniques were the same. Keywords: Epiphora, cautery technique, knife technique, nasolacrimal duct obstruction, endoscopic endonasal dacryocystorhinostomy, dacryocystitis.
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Kulak Burun ve Boğaz, Otorhinolaryngology (Ear-Nose-Throat)
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