The importance of lacrimal diaphragm and periosteum suturation in external dacryocystorhinostomy.

Abstract:

PURPOSE:To evaluate retrospectively the cosmetic and functional effects on success of lacrimal diaphragm and periosteum suturation after the anastomosis of anterior flaps before skin closure in external dacryocystorhinostomy (ext-DCR). METHODS:During ext-DCR, lacrimal diaphragm was separated from periosteum over anterior lacrimal crest before entering lacrimal fossa. At the end of ext-DCR, the separated periosteum and lacrimal diaphragm were sutured in the study group (270 patients) and were left unsutured in the age-matched control group (96 patients). The effects of this approach on postoperative appearance of incision area at the 6-month postoperative controls, and functional success (assessed by fluorescein disappearing test) and anatomical success rates (assessed by lacrimal syringing) at the 12-month postoperative controls were evaluated. RESULTS:The anatomic success rate between the 2 groups were found to be similar (94.8% and 92.7% in the study and control groups, respectively, p = 0.447). Fluorescein disappearing test was detected to be normal in 246 patients (91.1%) and 78 patients (81.2%) in the study and control groups, respectively (p = 0.009). Postoperative skin scar was found to develop significantly greater in the control group (p = 0.001). Significant hypertrophic scar was seen in 3 patients (1.1%) and 8 patients (8.3%) in the study and control groups, respectively. No epicanthal fold or webbing occurred in the study group. CONCLUSION:The preservation of the lacrimal sac wall's attachments at the end of ext-DCR to the medial canthal tendon, orbicularis oculi muscle, and lacrimal diaphragm allows the lacrimal pump to function more effectively. Ext-DCR with suturation of the periosteum and lacrimal diaphragm method may provide an excellent functional and aesthetic outcome in the majority of patients.

authors

Ciftci F,Dinc UA,Ozturk V

doi

10.1097/IOP.0b013e3181bb5942

subject

Has Abstract

pub_date

2010-07-01 00:00:00

pages

254-8

issue

4

eissn

0740-9303

issn

1537-2677

journal_volume

26

pub_type

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