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Obstruction of the lacrimal pathways is a relatively frequent problem usually corrected by external dacryocystorhinostomy. Failure of the external approach may be due to an inadequate rhinostomy, excessive scar tissue production, anatomical anomalies or concomitant paranasal sinus infectious. The introduction of direct and angled endoscopes for paranasal sinus surgery and the refinement of endoscopic surgical procedures allows a complete intranasal exposure and surgical management of the lacrimal sac, even in cases of recurrent obstruction. The present work offers a retrospective review of the records of seven patients who underwent a revision endoscopic dacriocystorhinostomy (ENDCR) between January 1994 and June 1997 for failed external dacryocystorhinostomy. The preoperative evaluation of the patients, the surgical technique and the postoperative management are examined in detail. A permanent dacryocystorhinostomy was obtained in six patients. One patient underwent a successful bilateral procedure. One patient experienced a persistent stenosis. There were no complications related to the surgical procedure. In our experience the revision endoscopic dacryocystorhinostomy offered several advantages, including a complete exposure of those anatomical anomalies or inflammatory changes of the normal structures that commonly hinder conventional external surgery. Although a larger series will further elucidate the efficacy of this procedure in failed external dacryocystorhinostomy, we recommend considering revision ENDCR as an alternative to the external revision technique.

Abstract: Obstructive sialadenitis is a major cause of dysfunction of the salivary glands, and increasingly sialoendoscopy is used in both diagnosis and treatment. At present the limit of the endoscopic approach is the size of the stone as only stones of less than 4mm can be removed. Endoscopic laser lithotripsy has the potential to treat many stones larger than this with minimal complications and preservation of a functional salivary gland. The holmium:YAG laser has been widely and safely used in urology, and its use has been recently proposed in salivary lithotripsy for the removal of bigger stones. We describe our experience with sialoendoscopy for stones in the parotid and submandibular glands and assess the feasibility and the efficacy of holmium:YAG laser lithotripsy. We have used the procedure 50 times for 43 patients with obstructive sialadenitis; 31 patients had sialolithiasis, 15 of whom (48%) had stones with diameters between 4 and 15mm (mean 7). Total extraction after fragmentation was possible in 14 of the 15 patients without complications. Intraductal holmium:YAG laser lithotripsy is effective and safe, and allows the treatment of large stones in Stensen's and Wharton's ducts. [Copyright &y& Elsevier]

Abstract: Narrow band imaging (NBI) is a novel method of imaging that increases the diagnostic potential of conventional endoscopy. It highlights abnormalities in the superficial vasculature of mucosal lesions so that precancerous or cancerous lesions can be identified more easily. Initially developed for the gastrointestinal tract, and widely used in other branches of medicine, it is now being used for the assessment of patients with malignancy in the head and neck. We review current published papers relating to NBI and discuss its benefits for early detection of cancer of the head and neck. [Copyright &y& Elsevier]

Abstract: Erythroplakia is an epithelial lesion that holds the highest risk of showing severe dysplasia or microinvasive carcinoma. The gold standard treatment is total excision to obtain a complete histopathological diagnosis. Traditionally this has been done by illumination of the lesion with white light, and resection with adequate margins. The difficulty with erythroplakia is that margins can be hard to delineate precisely, and even severe dysplasia can be seen with only subtle changes in the surface mucosa. Narrow band imaging is a novel technique that enhances the diagnostic potential of endoscopy. It highlights abnormalities in the superficial vasculature, which means that lesions such as oral erythroplakia can be identified more easily. We report its use in the identification of the full extent of lesions, and show its intraoperative advantages in obtaining resection margins free from disease. [Copyright &y& Elsevier]