Bilateral external dacryocystorhinostomy
Richard C. Allen, MD, PhD, FACS
Additional Notes: Length 02:15
This is Richard Allen at the University of Iowa. This video demonstrates the performance of a bilateral dacryocystorhinostomy. An incision has been made on each side of the nose with a 15 blade. Stevens scissors are used to bluntly dissect to the underlying periosteum. 4-0 silk traction sutures are placed through the sides of the incision for exposure. A Freer periosteal elevator is then used to elevate the periosteum from the underlying bone to the level of the anterior lacrimal crest. The lacrimal sac is then elevated from the lacrimal sac fossa. The thin bone of the posterior lacrimal sac fossa is then broken. A Kerrison rongeur is then used to make a generous ostomy. The nasal mucosa is infiltrated with 1% lidocaine with epinephrine. The area is packed with Afrin-soaked neurosurgical cottonoids. The co-surgeon is then given time to "catch up". The neurosurgical cottonoids are then removed. The puncta are dilated and a Bowman probe is placed to identify the medial extent of the lacrimal sac. An incision is made through the lacrimal sac to make anterior and posterior flaps. Corresponding incisions were made to the nasal mucosa. Posterior flaps are sutured together. The Crawford stents are placed through the system and retrieved from the nose. 4-0 silk sutures placed around the stents to prevent post-operative prolapse of the stents. The anterior flaps are then sutured together with the 5-0 chromic suture. The incisions are closed with deep interrupted 5–0 Vicryl sutures. The skin is closed with interrupted 5-0 fast-absorbing sutures. As this is bilateral procedure the procedure has been performed concurrently on the other side. In general, I believe that this is safe. The procedure is performed exact same manner. At the conclusion of the case erythromycin ophthalmic ointment is placed over the incisions and the patient returns for reevaluation in 1 week. The Crawford stents are removed in approximately 4 months.
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January 9, 2017