الفهرس 
Surgical anatomyOnly 14 pages are availabe for public view
 |  | from | 126 |  |  |
| | | from | 126 | | |
Abstract
Dacryocystorhinostomy (DCR) surgery is a procedure that allows tears to drain directly into the nasal cavity from the canaliculi via a new fenestrum with low-resistance pathway. A common reason for the failure of an EEDCR is the reclosure of the induced nasolacrimal stoma by granulation tissue and synechiae. Preservation of nasal mucosal flaps can help reduce the rate of granulation and synechiae formation and subsequently increase surgical success rate.
The objective of the present study was to assess the role of the lacrimal flaps in EEDCR surgery by comparing wide single nasal flap with sacrificing medial wall of lacrimal sac fenestrum EEDCR with narrow double nasal and lacrimal flaps fenestrum EEDCR in a double blinded randomized controlled trial.
Thirty-eight patients were divided randomly into two groups:
group A: 19 patients were subjected to Endonasal Endoscopic DCR with wide single nasal flap with sacrificing of medial wall of lacrimal sac fenestrum.
group B: 19 patients were subjected to Endoscopic DCR with narrow double nasal and lacrimal flaps fenestrum.
Follow up occured at regular visits at 3, 6 months and at the time of the end of the study. All patients were assessed subjectively by using Munk scale to assess symptoms, Lac_Q questionnaire to assess quality of life. Objectively by regurge test, dye disappearance test and Jones 1&2 test to assess function. Patient considered well function when regurge test negative, dye disappearance without delay and Jones I test positive. DOS scoring to assess the fenestra endoscopically.
Summary
96
The total symptoms improvement in both groups was 100%. Higher non-significant degree of symptoms improvement was in nasal and lacrimal flaps group (42.1% patients were symptoms free and 57.9% had significant to moderate improvement) than in the single nasal flap group (47.4% patients were symptoms free, 31.6% had significant to moderate improvement while 21.05% patients had minimal improvement).
All cases showed marked improvement in all parameters of quality of life assessment by using the Lac Q questionnaire in both groups
By evaluating all function tests simultaneously with lacrimal flaps preservation, all patients had preserved pump function, while with the sacrificed lacrimal wall, lacrimal pump was functional in 78.9%.
Slight differences were observed in endoscopic examination according to grading of the DOS total score; in (group A) 63.16 % of participants had excellent category ostium and 36.84 % had a good category while in (group B) 78.95 % of participants had excellent category ostium and 21.05 % had good category ostium. The decrease in the total DOS grade in the first group was related to a decrease in the ostia sizes.
In addition to wide ostium with low functionality observed in single nasal flap technique, the more non-significant incidence of complications was observed with a total of 52.63% compared to 31.58% in double flaps technique. In single nasal flap technique, absence of lacrimal flap tissue allowed more uncovered bones and subsequently granulation tissue formation at the edges in 31.58% and granulation tissue covering NLO in 10.53%.