Improving Results in Endonasal DCR by Double Posterior Based Flap Technique – Our Experience

Background: Endonasal DCR surgery is the most common surgical treatment of choice in chronic dacryocystitis. Different surgical techniques with new instruments have been evolved in past to ensure adequate epithelization at the lacrimal stomal site. Different nasal and lacrimal flaps have been designed for successful outcome in primary Endonasal DCR surgery. Aim: The aim of this study is to evaluate outcomes of double posterior - based flap technique in primary Endonasal endoscopic dacryocystorhinostomy (EEDCR) with and without the use of powered instrument. Material and Methods: Forty eight patients of nasolacrimal duct obstruction were included in this clinical observational study from Jan 2019 to June 2020. All patients underwent EEDCR with double posterior based nasal and lacrimal flap technique. In group A (24 patients) bone removal was done with Smith-Kerrison punch forcepes and in group B (24 patients) powered drill was used for lacrimal bone removal. Results: Out of 48 patients, 45 (93.50%) were found free of symptoms at the end of 1, 3 and 6 months. At the end of 12 months, 7 (14.58%) were found to have recurrence of symptoms of which 2 (4.16%) patients were from group A and 5 (10.41%) from group B. Postoperative complications were more with powered instruments (drill) compared to cold instrument. Double posterior – based flap technique without use of powered drill could be effective surgical option ensuring adequate early epithelization for successful outcome.