Modified Endoscopic Dacryocystorhinostomy using the Jansen - Middleton forceps

Authors: Kailun Jiang, Sarah Simpson, Karim Punja. 

Author Disclosure Block: K. Jiang: None. S. Simpson: None. K. Punja: None.

Abstract Body:

Purpose: To describe the safety and efficacy of a novel modified dacryocystorhinostomy (DCR) technique using the Jansen - Middleton forceps (JMF) to facilitate removal of the frontal process of the maxilla.
Study Design: Retrospective chart review.
Methods: Charts of consecutive endonasal DCR by one surgeon done between January 2015 to February 2019 were reviewed. Patients with less than 6 months of follow up or were under 18 years of age were excluded. Success was classified anatomically as >50% patency on irrigation and functionally as Munk score of <2.
Results: 102 DCR surgeries were done on 96 lacrimal systems of 72 patients. 65% of patients were female and 74% had complete nasolacrimal duct obstruction (NLDO). The average age was 50.3 years. 25 patients (34.7%) had bilateral lacrimal drainage surgery. The average duration of post-surgical follow up was 24 months. Anatomical success was 93.8% in all comers. The rate of anatomical success in those who underwent primary DCR surgery was 93.4%.5 lacrimal systems from 4 patients had prior DCR performed elsewhere. JMF was used in all revision DCR and was successful in all patients. Of the remaining 91 lacrimal systems that had undergone primary DCRs, 6 lacrimal systems failed anatomically (6 patients). All 6 patients went on to have redo DCR which were successful in 4 cases. JMF was used in 2 of these 6-primary failed DCRs (JMF was not used in the 2 failed redo-DCR). 85 lacrimal systems were successfully (anatomically) treated with primary DCR (JMF was used in 70.6% of these cases). Of these anatomical successes, functional success was obtained in 73 lacrimal system (80.2%).In primary DCR, the anatomical success rate was 98% in cases using JMF and 83% in those where the JMF was not used. This was statistically significant (Fisher’s exact test, p=0.014). There were no intraoperative complications and no cases of postoperative CSF leak.
Conclusions: This modified technique for endonasal DCR is safe and effective for treatment of NLDO with favorable anatomical success rates as compared to literature. The use of JMF was associated with an increased rate of success; the design and angulation of the forceps better facilitates engagement and removal of the thicker and more challenging frontal process of the maxilla.