Dacryocystorhinostomy

DACRYOCYSTORHINOSTOMY, dacryocy-storhinostomia, an operation by which direct communication is established between the cavity of the lacrimal sac and the nasal cavity, bypassing the nasolacrimal duct. Proposed as an alternative to excision of the lacrimal sac in cases of persistent dacryocystitis, D. should create new artificial drainage conditions for tear fluid, freeing the patient from troublesome tearing and from the dangerous discharge of pus from the lacrimal sac into the conjunctiva, which threatens the integrity of the eyeball. There are 2 main methods of this operation, each with numerous modifications. 1. The extranasal, orbital method (Toti, 1904; Dupui-Dutemps and others), practiced by ophthalmologists. The skin incision is made as in excision of the lacrimal sac; then the inner wall of the sac is exposed and dissected. With a chisel or trephine, a large (12x8 mm) oval opening is made in the bony wall of the lacrimal fossa. With a longitudinal incision, the wall of the sac is opened and the mucous membrane of the nose, exposed after removal of the bone, is incised; the corresponding edges of the incisions are sutured with catgut (see figure). Thus, the cavity of the lacrimal

Dacryocystorhinostomy according to Dupui-Dutemps (6 consecutive moments).

sac is widely opened into the nasal cavity as its newly formed diverticulum. Depending on the method of incising the coverings, the technique of bone removal, the method of opening the lacrimal sac and nasal mucosa, and whether or not sutures are applied to connect the nasal mucosa and the sac, individual modifications of the operation are distinguished. 2. The intranasal method, practiced mainly by rhinologists (West, 1910; Polyak). The operation is performed from the nasal side. The nasal mucosa is removed at the site corresponding to the position of the lacrimal sac, and a large bony window is punched through to communicate with the nasolacrimal duct and lacrimal sac. Both methods are currently being intensively developed and improved, displacing the old method of excision of the lacrimal sac (see Dacryocystitis). Complete cessation of discharge into the eye, tearing from the eye, and the stability of the achieved result - from these three points of view, the main methods and their modifications are evaluated. In general, statistics speak in favor of D.