Endoskopická endonazálnídakryocystorinostomie v dětském věku

Endoscopic Endonasal Dacryocystorhinostomy in Child Age

The authors present an analysis of 23 endonasal endoscopic dacryocystorhinostomies(EEDCR) which they performed in 1996 - 1999 in 20 children. The youngest child was nine monthsold, the oldest 13 years, the mean age was 4.7 years. The cause of occlusion of the lacrimal pathwayswas in 18 children congenital occlusion, in six instances with chronic dacryocystitis, twice obstruc-tion developed after a dog bite. Indication for surgery was subsaccal obstruction (16x) or a combi-nation of subsaccal and suprasaccal obstructions (5x) and in two instances suprasaccal obstruction.Six children had before DCR an unsuccessful intubation of the lacrimal pathways.The operation proper was in all patients made under general anaesthesia. The operation wasbilateral in three children, once performed in one stage and twice after 6 and 8 months resp.following the first operation. Three times during the operation the frontal olfactory sinuses wereopened, three times the head of the median concha was resected. In 14 primary DCRs the authorsused a bicanalicular stent, in five a monocanalicular stent, in four children they did n ot use a stent.With the exception of two cases when penetration into the orbit occurred, antibiotics were not used.The results were evaluated six months after the operation, based on subjective evaluation and bymeans of FDDT (Fluorescein Dye Disappearance Test). A total of 22 EEDCR were evaluated (onepatient did not attend the check-up examination). In primary EEDCR 18 of 22 cases (81.8%) weresuccessful. Three of thelatter were re-operated by the same technique and all were cured. In thetotal, i.e. incl. revisions, surgery was successful in 21 of 22 patients (95.45%). In three children witha bilateral operation surgery was successful in all instances. Of 16 subsaccal obstructions primaryDCR was successful in 14 (87.5%), of 5 combined subsaccal and suprasaccal obstructions success wasachieved in three (60.0 %) and one suprasaccal obstruction was successful.According to the authors the lower age range for surgery is 6-8 months. If possible they prefer beforeDCR intubation of the lacrimal pathways. EEDCR calls for a careful approach to the nasal mucosawith regard to the small dimensions of the nasal cavity and also with regard to poorer postoperativecooperation. Therefore it is better to reduce the risk of scarring of the rhinostomy stents. Mostfrequently bicanalicular stents are used. EEDCR in children is an operation where the results arecomparable with those in adults.

Key words:
dacryocystorhinostomy, endonasal endoscopic DCR, indication of DCR, inborn obstruc-tion of the lacrimal pathways, stents.