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PurposeMethodsResultsConclusionsTo determine the risk factors impacting the surgical success of endonasal dacryocystorhinostomy (eDCR) in pediatric patients.This is a retrospective interventional case series of patients 18 years and younger treated over a 16-year period via eDCR for nasolacrimal duct obstruction (NLDO). Data were extracted on surgical outcomes, follow-up duration, and comorbidities (i.e. punctal agenesis, trisomy 21, dacryocystitis). Functional success was defined as the resolution of NLDO symptoms postoperatively.Of 356 cases in 281 patients (median age: 3.32 years), 78.9% of cases in 79.0% of patients achieved functional success after initial eDCR. The median follow-up duration without tearing symptoms as observed by an ophthalmologist and non-ophthalmology trained clinician was 11.0 months and 62.1 months, respectively. Patients with punctal agenesis and those requiring bilateral surgery had significantly higher rates of failure (p = .01; p < .001, respectively). Age at operation was not significantly associated with failure (p = .30). Excluding cases of trisomy 21 and punctal agenesis, functional success was achieved in 82.7% of 295 cases.Endonasal DCR is effective in resolving NLDO symptoms in pediatric patients, with success rates comparable to the adult population and to an external approach. Despite a higher reoperation rate in patients with trisomy 21 and punctal agenesis, trisomy 21 and age at operation were not significant risk factors for failure. [ABSTRACT FROM AUTHOR]

Dacryocystitis, inflammation and infection of the lacrimal sac, is most commonly caused by infection from Staphylococcus and Streptococcus species. This report highlights a rare case of chronic dacryocystitis due to the atypical pathogen Mycobacterium abscessus. A 62-year-old woman presented with several months of left medial canthal pain, tenderness, and discharge. Exam demonstrated a left tender medial nodule, and imaging showed left lacrimal sac dilation and fluid collection consistent with dacryocystitis. She underwent external dacryocystorhinostomy with drainage and culture of the abscess, which was positive for M. abscessus. Her post-surgical treatment required an extended course of antibiotics, including omadacycline and azithromycin, with slow but progressive symptomatic improvement. This case is only the second reported case of dacryocystitis due to M. abscessus and suggests a role for culturing lacrimal sac abscesses intraoperatively due to the need for extended antibiotic therapy for atypical infections that may have high antibiotic resistance. [ABSTRACT FROM AUTHOR]

The editorial delves into the history and development of oculoplastic surgery training in Europe, highlighting key figures and the establishment of training programs while addressing disparities in training standards across European countries. It emphasizes the importance of standardizing training requirements and raising awareness about oculoplastic surgery as a subspecialty. The article also explores the potential of artificial intelligence in improving patient care, surgical training, and clinical research, along with ethical considerations in AI and open access publishing. Francesco M. Quaranta-Leoni, the author, is an expert in ophthalmoplasty and orbital and adnexal services, affiliated with institutions in Italy. [Extracted from the article]

Background: The aim of our study was to determine the success of endoscopic endonasal dacryocystorhinostomy using powered instrument (microdebrider) and removing the nasal mucosal and posterior saccal flaps. Methodology: A prospective hospital based case study was conducted in patients attending ENT, Head & neck surgery department of Government Medical college hospital between April 2023 to April 2024 with complaint of epiphora including nasolacrimal duct obstruction. A total of 30 cases of epiphora secondary to nasolacrimal duct obstruction were operated using endoscopic endonasal DCR technique. Result: Complete resolution of epiphora was reported in 28 patients of the 30 procedures, (93.3% success rate) with patent ostia on syringing. None of the patients developed recurrence, 2 patients developed synechiae and mucosal overgrowth over the canalicular sight post operatively. There were no intra-operative or post-operative complications. Conclusion: The technique of endoscopic dacryocystorhinostomy with creation of wide bony ostium around the medial aspect of the lacrimal sac by drilling out the bony borders and removing mucosal and posterior saccal flaps with the help of powered instrument (microdebrider and drill) has shown good longterm results comparable with other studies. It also has the additional advantage of less granulation tissue formation, less chance of redundant flap obstructing the ostia and practically no synechiae formation. The technique is relatively easy with favourable outcome. [ABSTRACT FROM AUTHOR]

Dacryocystorhinostomy (DCR) stands as an essential surgical procedure for addressing the persistent challenge of dacryocystitis—a condition marked by inflammation of the lacrimal sac due to nasolacrimal duct obstruction. A hospital-based retrospective study was conducted in a tertiary care hospital, spanning the years 2018 to 2023, involving 34 patients who underwent Endoscopic Dacryocystorhinostomy. The study involved the examination of their clinical presentations, surgical techniques employed, and resulting outcomes along with causes of failure. Our study included 34 patients who had presented with persistent watering of eyes. The maximum number of cases was in the age group of 46–60 years (38%), with a minimum age of 7 years and a maximum age of 68 years. Among those 34 patients, 5 underwent a revision DCR. Fifteen patients underwent stenting. Thirteen of the fifteen patients, who underwent stenting came for regular postoperative follow up and stent removal was done 6 to 8 weeks later. The two patients who were lost to follow-up presented after 4 years of their initial surgery with persistent symptoms. The success rate of endoscopic DCR was 94% in our study. Endoscopic Dacryocystorhinostomy has emerged as a practical solution for addressing nasolacrimal duct obstruction. Despite numerous surgical modifications documented over time, the endoscopic DCR technique consistently demonstrates excellent outcomes with minimal patient morbidity. This study underscores the significance of thorough preoperative assessment, making informed decisions regarding stenting during both the preoperative and intraoperative period, employing proper surgical techniques, and recognizing the importance of regular post-operative follow-up. [ABSTRACT FROM AUTHOR]

Epiphora is an annoying symptom, embarrassing the patient both socially and functionally. The two widely accepted treatment modalities of epiphora resulting from obstruction of the nasolacrimal ductus are external and endoscopic dacryocystorhinostomy (DCR). To compare the outcome of endonasal endoscopic dacryocystorhinostomy with stent and without stent prospectively and to compare the outcome of endonasal endoscopic dacryocystorhinostomy with stent and without stent with external dacryocystorhinostomy retrospectively. This retrospective and prospective clinical interventional study was done in the Department of Otorhinolaryngology and Institute of Ophthalmology, Jawaharlal Nehru Medical College, A.M.U., Aligarh from July 2012 to September 2017. 110 patients of epiphora participated in the study and were divided into three groups: Group I: Endoscopic endonasal dacryocystorhinostomy with stent. Group II: Endoscopic endonasal dacryocystorhinostomy without stent. Group III: External dacryocystorhinostomy. Out of them 60 patients were for Endoscopic dacryocystorhinostomy (30 patients with stent and 30 patients without stent) and 50 patients were for External dacryocystorhinostomy. 71 (65%) were females while 39 (35%) were males (p < 0.05) with age ranging from ranging 8–60 years (mean 34.96 years) with predominance of symptoms in left eye (p < 0.01). A lower complication rate was observed in the endoscopic group, with minimal morbidity and shorter operative time compared with the external approach. Follow up was done at postoperative day 1st and 7th, at 2 weeks, 4 weeks and 3 months for assessing complications of operation, symptomatic relief of epiphora and syringing for anatomical patency. In our study, Success rate was 93.30% in Group I and 96.60% in Group II while 90% in group III. The avoidance of a cutaneous scar has been a strong impetus to further the success and improve outcomes of endonasal DCR. Endonasal DCR without stent has lesser incidence of post-operative fibrosis and higher patient's acceptance. [ABSTRACT FROM AUTHOR]

A bibliometric analysis concluded that the evaluation of post-operative outcomes of endoscopic dacryocystorhinostomy in Indonesia had yet to be done. Hence, this study aims to assess the postoperative outcomes of endoscopic dacryocystorhinostomy, focusing on ostium granulation, intranasal synechiae, membranous obstruction, and ostium stenosis after a three-month follow-up in our Indonesian center. A longitudinal study (2017–2023) at our Indonesian center included cases with a minimum of three-month follow-up. Nasal endoscopy assessed ostium granulation, intranasal synechiae, membranous obstruction, and ostium stenosis. 28 cases were successfully followed up for three months. At three months, ostium granulation was present in 42.9% of cases, membranous obstruction in 14.3% of cases, with no intranasal synechiae or ostium stenosis observed. Out of 28 cases, 13 were successfully followed for six months, revealing ostium granulation in 7.7%, membranous obstruction in 38.5%, and ostium stenosis in 23.1%. Ostium granulation predominates, followed by membranous obstruction at three-month follow-up. Ostium stenosis, a minimal occurrence, manifests after six months. [ABSTRACT FROM AUTHOR]

Pre-saccal obstructions of the lacrimal duct can be solved with a conjunctivodacryocystorhinostomy while saccal or post-saccal obstructions are restored with an external, endoscopic or laser dacryocystorhinostomy (DCR). The aim of the present study is to review the indications for each technique and to compare the results achieved. Retrospective review of 335 patients in whom 440 surgeries of the lacrimal duct were performed, with at least 4 months of follow-up. Outcomes in terms of symptoms and endoscopic findings during follow-up were considered. Successful results understood as resolution of symptoms were observed in 85% of cases treated with endoscopic DCR and in 62% of cases after laser DCR (p < 0.001). Among patients with recurrence of epiphora after surgery, 32% showed a visible ostium during endoscopy. Sixty-eight conjunctivodacryocystorhinostomies were performed, 68% of which required a tube replacement due to obstruction or extrusion. The mean duration of the tubes replaced was 10 months (range 3 days – 95 months). Endoscopic DCR shows better success rates than laser DCR. A considerable percentage of failures after DCR surgery present a visible ostium on endoscopic examination. This fact should lead to reconsider the initial diagnosis, ruling out functional problems or canalicular obstructions. [ABSTRACT FROM AUTHOR]

This article provides an overview of the historical contributions made by the Babylonians, Ancient Egyptians, Medieval Arabs, and Persians to the understanding and treatment of lacrimal drainage disorders. It highlights the Code of Hammurabi, which contains laws related to lacrimal sac abscesses, and the Ebers Papyrus, which documents treatments for lacrimal sac inflammations. The text also discusses the works of physicians like Al-Razi and Ibn-Sina, who made significant contributions to ophthalmology in the Middle Ages. It emphasizes the importance of understanding these ancient descriptions in their historical context and acknowledges that our understanding of lacrimal diseases has evolved over time. The author concludes by stating that there is still much to learn in this field. [Extracted from the article]

Purpose: Sinonasal mucoceles (SM) are benign, expansive neoformations which require surgical marsupialization to prevent severe complications. The present study reports the larger case history ever published: a 28-years expertise in the surgical management of SM. Methods: A retrospective study was conducted on patients surgically treated for SM at the Departments of Otorhinolaryngology of Varese and Pavia, between 1994 and 2022. Results: 398 patients were reported. An endoscopic endonasal marsupialization of SM was performed in 92,5% of cases. 7% of patients underwent a combined approach while 0,5% required an exclusive open surgery. The average follow-up after surgery was 10–60 months. SM overall recurrence was observed in 11,4% of cases. Conclusion: Endonasal endoscopic SM marsupialization is a feasible technique which allows the preservation of the anatomy and physiology avoiding the surgical invasiveness of the external approaches. The well-established surgical expertise in the endonasal endoscopy together with technological improvements widened the indication range of the exclusive endoscopic technique over the traditional open surgery. [ABSTRACT FROM AUTHOR]

This is a rare case of a patient who developed a relapse of dacryocystitis and maxillary sinusitis although previous dacryocystectomy. We decided to perform an external dacryocystorhinostomy to remove the scar and the residual part of the lacrimal sac combined with endoscopic sinus surgery (ESS) to solve the symptoms. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionsThis study aimed to quantify the proportion of patients with bilateral epiphora and suspected nasolacrimal obstruction who self-reported improved epiphora bilaterally following unilateral dacryocystorhinostomy and investigate predictive factors.A retrospective cohort study of patients from an Australian lacrimal clinic was performed. Eligible patients were at least 18 years of age, complained of bilateral epiphora, underwent unilateral dacryocystorhinostomy between 2012 and 2022 and followed-up. Outcome groups were created by grouping self-reported epiphora improvement levels for each eye. Two-sided confidence intervals were calculated for the proportion of participants in each outcome group. Ordinal elastic net regression identified clinical features associated with outcome groups and estimated their effect sizes.Of 243 patients, the median post-operative follow-up duration was 3 months. Fifty-eight percent (95% CI 52–64%, n = 141) reported significant improvement (≥50% ipsilateral and any contralateral improvement), 5% (95% CI 3–9%, n = 13) reported small improvement (<50% ipsilateral and any contralateral improvement) and 26% (95% CI 20–31%, n = 62) reported ipsilateral improvement only. Eleven percent had functional or anatomical failure. Older age (OR 1.01), contralateral nasolacrimal duct narrowing (OR 1.37), contralateral nasolacrimal duct obstruction (OR 0.93) and longer follow-up time (OR 0.85) predicted outcome groups.After unilateral DCR, many patients with bilateral epiphora and suspected nasolacrimal obstruction report an improvement of their symptoms bilaterally in the early postoperative period. Contralateral nasolacrimal system diagnosis, patient age and follow-up duration were associated with outcomes. Further study using validated epiphora assessment tools may quantify this observation, and we suggest a potential underlying mechanism of contralateral effects after unilateral treatment. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionsTo compare the long-term outcomes of mucosal-sparing mechanical endoscopic dacryocystorhinostomy (MMED) for primary acquired nasolacrimal duct obstruction (PANDO) with or without silicone intubation.An 11-year follow-up study of the Silicone intubation in Endoscopic Dacryocystorhinostomy (SEND) randomized controlled trial (RCT) was conducted at a university-affiliated dacryology clinic from December 2019 to March 2023. Questionnaires on symptoms, anterior segment examination, endoscopic examination with functional endoscopic dye test (FEDT) and FICI grading, and ostial size measurements using Image J software were performed by a masked ophthalmologist. The primary outcome was surgical success, defined by Munk’s score ≤1 and a positive fluorescein endoscopic dye test. Secondary outcomes included risk factors for failure and outcomes of revision surgeries.Fifty-three of the original 118 patients were evaluated at 155 ± 21 (136–218) months postoperatively. Seventy-seven percent (46/60) ostia remained successful, including 70% (19/27) of unstented and 82% (27/33) of stented ostia (p = .3). Stented ostia had larger size (p = .003), but this did not confer higher success (p = .14). Successful ostia had higher FICI scores and better ostial dynamicity (p < .05). Ostium movement was the only parameter associated with surgical success on multivariate analysis (OR 13.1, p = .01). Four (1 stented) underwent revision MMED, intraoperative mitomycin-C, and 12-week intubation. All revision ostia were functional after 141 ± 43 months.Surgical success of MMED after 11-years was 77%, a notable reduction compared to 96% success at 1-year. Statistical advantage of silicone intubation for primary MMED was not demonstrated, though clinically, stented ostia had a higher success (82% vs 70%). The presence of a dynamic internal common opening was highly associated with long-term surgical success. [ABSTRACT FROM AUTHOR]

Background/Objectives: The aim of the study was to compare dacryocystectomy (DCT) versus dacryocystorhinostomy (DCR) in patients with dacryocystitis in terms of tearing complaints. Methods: We conducted a retrospective and comparative study on 19 patients. The main outcome measure was defined as an improvement by 1 point of the Munk score postoperatively. Results: A total of 19 patients were included with 10 in the DCR group and 9 in the DCT group. The primary endpoint was reached in 7 (70%) and in 6 (67%) patients in the DCR and DCT groups, respectively (p > 0.999). All DCR procedures were performed under general anesthesia (GA), while almost all DCT procedures were performed under local anesthesia (LA) (p < 0.001). There was a higher need for hospitalization in the DCR group (p < 0.001). Conclusions: Our preliminary results indicate that DCR is not always the solution in the case of dacryocystitis. DCT is a viable surgical procedure, especially in elderly patients without any tearing complaint and with underlying dry eye disease. [ABSTRACT FROM AUTHOR]

Laser dacryocystorhinostomy (LDCR) is a surgical procedure designed to treat obstructions in the lacrimal duct system, which can cause excessive tearing, infections, and discomfort. This technique involves creating a new passage for tear drainage, thereby restoring normal tear flow and alleviating symptoms associated with duct obstruction. A retrospective study was conducted on 48 patients who underwent the LDCR procedure, amounting to 56 eyes. The primary outcome measured was the anatomical success rate, defined as the restoration of duct patency. Patients were examined postoperatively from 6 months to 3.5 years. The LDCR method demonstrated a 95% success rate, encompassing both anatomical and functional outcomes. The procedure's effectiveness was determined by achieving a patent osteotomy and resolving symptoms. Anatomical success was measured by the creation of a viable drainage pathway, while functional success pertained to the resolution of symptoms such as epiphora. The efficacy of the procedure was found to be independent of both age and gender. Among patients with successful anatomical outcomes, there was a statistically significant improvement in their Munk scores. The LDCR method is highly effective in treating lacrimal duct obstruction. These findings highlight the importance of the Munk score as a predictive indicator of procedural success in LDCR. [ABSTRACT FROM AUTHOR]

Background: Utilizing expanded endoscopic approaches to the maxillary sinus for the endonasal management of a variety of tumors is increasing in popularity. The nasolacrimal duct (NLD) may be injured inadvertantly or need to be removed during tumor resection or to augment visualization. Management of the NLD can take the form of transection alone, transection with stenting, or performing a formal dacryocystorhinostomy to avoid postoperative sequelae of injury. The purpose of this study was to review the literature and determine the optimal management of the NLD during expanded maxillary sinus approaches. Methods: A systematic review of Ovid, Embase, Medline, and Cochrane databases was performed to identify studies involving expanded approaches to the maxillary sinus and that explicitly reported the status of the NLD and postoperative outcomes. Results: Nineteen studies were included in the analysis and divided into two groups: NLD-preserving (n = 9 studies; n = 191 patients in aggregate) and NLD-involving (n = 10 studies; n = 296 patients in aggregate). In the NLD-preserving subgroup, one patient out of a subgroup aggregate of 191 patients (0.5%) developed epiphora. In the NLD-involving subgroup, sharp transection alone was the most common method of NLD removal and was associated with a low rate of epiphora (study rates: 0 to 18.2%; aggregated subgroup rate: 7.0%, 21 / 296). Spontaneous resolution of symptoms was common (60%-100% cases). Conclusions: The NLD should be preserved when feasible from an exposure and tumor-control perspective. When pathology or approach requires the removal of the NLD, rates of persistent epiphora are very low, regardless of surgical technique. When expanded maxillary approaches are employed, particularly for benign tumors, and require removal of the NLD, sharp transection is the simplest method of removal, provides a low rate of postoperative epiphora, and is supported by the available literature. [ABSTRACT FROM AUTHOR]

Abstract Background To determine the paranasal changes and inflammatory markers that may cause primary acquired nasolacrimal duct obstruction (PANDO) and to determine their relationship with success rates on different types of surgeries. Main body We retrospectively reviewed the blood sample and computed tomography (CT) results on 92 patients who underwent dacryocystorhinostomy (DCR) surgery for PANDO and 82 healthy controls. Age, gender, paranasal abnormalities, hemogram values, International Normalized Ratio (INR) values, type of surgery, and recurrence rate were recorded; systemic Immune-inflammation Index (SII), neutrophil-to-lymphocyte ratio (NLR), monocytes-to- lymphocyte ratio (MLR) and platelet-to-lymphocyte ratio (PLR) were calculated in both groups. In the case group, total white blood cells, monocytes, and INR values were significantly lower (p 0.05). There was no significant difference in the CT results between the groups (p > 0.05). No correlation was found between CT findings and inflammatory markers. Dacryocystitis (DC) was seen in 20% of patients and they were all in the case group. No correlation was found between recurrence rate and age, gender, type of surgery, CT findings, and blood results (p > 0.05). The recurrence rate was significantly higher in patients with bilateral PANDO and with DC (p

Leprosy, also known as Hansen disease, is an airborne spread disease caused by Mycobacterium leprae (M. leprae) which commonly presents with skin lesions, peripheral neuropathy, and ocular involvement. This report describes a patient who presented with epiphora secondary to chronic nasolacrimal duct obstruction four years after completing antimicrobial treatment for tuberculoid leprosy. At the time of endoscopic dacryocystorhinostomy (DCR), the lacrimal sac demonstrated chronic dacryocystitis with granulomatous inflammation and a Fite positive staining bacterial rod-like structure. Pathological examination of the surgical specimen demonstrated numerous non-necrotizing granulomas in a perivascular and neural distribution, compatible with sequelae of previously treated M. leprae infection. The patient has remained symptom free six months after surgery. [ABSTRACT FROM AUTHOR]

Background: To determine the paranasal changes and inflammatory markers that may cause primary acquired nasolacrimal duct obstruction (PANDO) and to determine their relationship with success rates on different types of surgeries. Main body: We retrospectively reviewed the blood sample and computed tomography (CT) results on 92 patients who underwent dacryocystorhinostomy (DCR) surgery for PANDO and 82 healthy controls. Age, gender, paranasal abnormalities, hemogram values, International Normalized Ratio (INR) values, type of surgery, and recurrence rate were recorded; systemic Immune-inflammation Index (SII), neutrophil-to-lymphocyte ratio (NLR), monocytes-to- lymphocyte ratio (MLR) and platelet-to-lymphocyte ratio (PLR) were calculated in both groups. In the case group, total white blood cells, monocytes, and INR values were significantly lower (p < 0.05). Platelet, lymphocyte, neutrophil, PLR, MLR, NLR, and SII values did not differ significantly between the control and case groups (p > 0.05). There was no significant difference in the CT results between the groups (p > 0.05). No correlation was found between CT findings and inflammatory markers. Dacryocystitis (DC) was seen in 20% of patients and they were all in the case group. No correlation was found between recurrence rate and age, gender, type of surgery, CT findings, and blood results (p > 0.05). The recurrence rate was significantly higher in patients with bilateral PANDO and with DC (p < 0.05). Short conclusion: The incidence of PANDO may not be directly related to paranasal abnormalities and systemic inflammation. Low INR values may cause obstruction in the nasolacrimal duct. Age, gender, type of surgery, CT findings, and inflammation level do not affect the success of the surgery. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to evaluate the impact of treatment on psychological well-being by looking at changes in anxiety and depression levels in patients receiving treatment for tear duct obstruction. Materials and Methods: Forty patients who had been diagnosed with tear duct obstruction and receiving dacryocystorhinostomy (DSR) were included in our prospective cohort study. The Beck Anxiety and Depression Inventory, two standardized psychometric measures, were used to measure the individuals' levels of anxiety and depression both before and after DSR treatment. Results: The study comprised 40 patients in total, 16 (40%) of whom were male and 24 (60%) of whom were female. The number of patients in the "minimal anxiety" class climbed to 37 (92.5%) after DSR, compared to 22 (55%) patients in the class prior to DSR, based on the patients' anxiety levels. There was a significant change (p<0.001) in the median Beck anxiety scores before and after DSR. The median was 0 after it was 6.5 previously. There was a significant change (p<0.001) between the median Beck depression ratings before and after DSR. The median after was 13, compared to the prior median of 14. The results indicate that the scores for anxiety and depression decreased in a way that was statistically significant. Conclusion: In summary, this study represented a significant advancement in our understanding of the anxiety and sadness experienced by patients having DSR for tear duct obstruction. The study's noteworthy reduction in the levels of depression and anxiety implies that DSR might be beneficial for psychological as well as physical health. [ABSTRACT FROM AUTHOR]

Aim: We aimed to investigate the effective factors to increase treatment options in patients with congenital nasolacrimal duct obstruction (LDO). Materyal and Methods: Our study was planned retrospectively. The patients admitted to Erzurum Regional Training and Research Hospital Family Medicine Outpatient Clinic with symptoms such as watering, burring, swelling in the sac area, chronic conjunctivitis < In 200 children under 4 years of age, information on maternal age, mode of conception, gender, birth weight, mode of delivery, presence of multiple pregnancies, sibling history, duration of hospitalization, need for invasive mechanical ventilation, maternal pre-eclampsia, gestational DM, and bilateral or unilateral occlusion, need for surgery, number of surgeries, presence of anisometropia, when epiphora started and when it ended were collected and evaluated. Results: Of the children included in the study, 52% (n=103) were male and 48% (n=95) were female. It was shown that complaints such as watering, redness, and burring due to congenital nasolacrimal duct obstruction mostly started in the first weeks (7.1%), and most of these complaints were relieved by massaging the sac area and topical drops (90.3%) without surgical intervention. There were no significant statistical differences between children with and without congenital epiphora in terms of gender, multiple pregnancies, mode of delivery, delivery week, need for postnatal intensive care, mother’s mode of conception, maternal age and chronic diseases (p>0.05). Significant differences were found in birth weight and the presence of positive sibling history (p<0.05). Conclusion: This study was conducted to evaluate the association of congenital epiphora with possible antenatal and perinatal risk factors. It was concluded that low birth weight and positive sibling history may be involved in the etiopathogenesis of epiphora, but it was concluded that studies on this subject should be conducted by reaching large populations. [ABSTRACT FROM AUTHOR]

To evaluate results and failure factors in endonasal surgery in a private outpatient setting in a tropical environment. A single-center observational study included 337 patients consecutively undergoing endonasal surgery in a private hospital on Réunion Island, a French overseas administrative Département in the Indian Ocean between 2019 and 2021. The main objective was to assess the success rate of the outpatient pathway. Secondary objectives comprised analysis of complications and identification and management of factors for failure of outpatient management. The study was conducted according to the STROBE editorial guideline. The 337 surgeries notably comprised 112 septoplasties (37.5%), 104 meatotomies (30.3%), 15 unilateral total ethmoidectomies (4.6%), 48 bilateral total ethmoidectomies with sphenoidotomy (14.3%), and 18 Draf procedures (5.5%). Seventy-five percent of patients (252/337) were operated on as outpatients, with a success rate of 90% (227/252 patients). The rate of severe intraoperative complications was 1.5% (5/337). On multivariate analysis, 3 variables were identified as influencing risk of failure of the outpatient pathway: emergency analgesia in the operating room [odds ratio (OR): 91.61; 95% confidence interval (CI): 22.8–540.3], operating time (OR: 1.05; 95% CI: 1.01–1.09), and recovery room time (OR: 1.02; 95% CI: 1.01–1.03). Our study in a tropical environment found eligibility and success rates for outpatient endonasal surgery similar to those in metropolitan France. This makes surgical and anesthesiological training a key factor in the success of outpatient care, while the location of the care structure and the climate seem to have little impact. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsDiscussionTo assess a novel Virtual Reality (VR) tool designed to enhance understanding of the nasal anatomy in patients eligible for DCR surgery.Preoperative Computed Tomography (CT) scans of the orbit were obtained and loaded as DICOM (Digital Imaging and Communications in Medicine) files onto the D2P software (3D Systems Inc. Littleton, CO) for tissue segmentation and 3D model preparation. Segmentation was performed on several anatomical structures, including the skull, lacrimal sac, nasal septum, inferior and middle turbinate. The resulting 3D model was visualized using a VR headset. After completing the segmentation procedure, ten cases were evaluated by a panel of six surgeons, including both senior and resident physicians from ENT and oculoplastic specialties.The dataset under examination comprised images from 10 preoperative CT scans of the orbits of patients eligible for Endo-DCR. When evaluating the CT using the VR tool, in 73.3% of the cases ENT surgeons were right about the side of pathology, while only 43.3% ophthalmologists were right (chi-square, p = .018). In 72.8% of the cases ENT surgeons were evaluated right that there is a septum deviation, while only in 47.2% of the cases the ophthalmologists were right (chi-square, p = .094).When evaluating the CT using the VR tool, in 60% of the cases consultants were right about the pathology, while 57.7% of the residents were right (chi-square, p = .853). In 81.7% of the cases consultants were evaluated right that there is a septum deviation, while only in 58.3% of the cases the ophthalmologists were right (chi-square, p = .198).ENT surgeons, as well as consultants, interpreted the CT better than the ophthalmologists and residents. Surprisingly, the VR system did not help them to interpret the CT better. Further, more extensive studies should be done to build a VR system that assists in the correct interpretation of the preoperative CT before DCR surgery as well as during DCR surgery. [ABSTRACT FROM AUTHOR]

Background: Large and giant pituitary adenomas (defined as tumors of maximal diameter ≥ 3–3.9 cm and ≥ 4 cm, respectively) present considerable surgical challenges regarding the extent of resection and perioperative morbidity. Endoscopic endonasal resection is considered the most effective treatment for pituitary adenomas. It allows for better visualization, maneuverability, and access to distant and lateral tumor compartments, ultimately enhancing the extent of resection. This article evaluates our initial experience with endoscopic endonasal resection of large and giant pituitary adenomas. The clinical outcomes, perioperative complications, and extent of tumor resection would be specifically addressed. Patients and methods: The primary goal of surgery was to decompress the optic pathways, and the secondary goals were to achieve maximal safe resection and hormonal control in hormone-secreting adenomas. The degree of tumor resection was classified as gross-total resection (100%), near-total resection (90–100%), subtotal resection (70–90%), and partial resection (< 70%). Results: 42 patients were included in this study. A good visual outcome achieved with 80% improvement in visual symptoms. Gross-total resection (GTR) was achieved in 19 patients (45.2%), near-total resection (NTR) was achieved in 12 patients (28.6%), subtotal resection (STR) in 6 patients (14.3%), and partial resection in the remaining 5 patients (11.9%). Subgroup analysis revealed that GTR, NTR rates were higher in large, compared to giant tumors. GTR, NTR rates of large adenomas were 59.3%, and 29.6%, compared to 20%, and 26.7% in giant adenomas respectively (p-value: 0.01428). Surgical complications were observed in 19 patients (45.2%) with CSF leakage being the most common complication (11 patients, 26.2%). Post-operative diabetes insipidus was observed in 5 patients (11.9%), major vascular injury in one case (2.4%), transient post-op 6th nerve palsy observed in 3 patients (7.1%), while two patients (4.8%) presented with post-operative paranasal sinuses infection. Conclusions: Endoscopic endonasal transsphenoidal resection of large and giant pituitary adenomas is a safe and efficient procedure. Large adenomas (3–3.9 cm) have excellent resection rates and lower complications than giant adenomas (≥ 4 cm), which may require extending our approach to achieve more tumor resection rates in the future. However, only adequate resection of these giant adenomas can be enough to achieve the main surgical goals of visual improvement, hormonal control, and decompression of surrounding structures. [ABSTRACT FROM AUTHOR]

Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) through ducts B2 or B3 is effective in most patients with biliary obstruction, because B2 and B3 commonly join together. However, in some patients, B2 and B3 do not join each other due to invasive hilar tumors; therefore, single-route drainage is insufficient. Here, we investigated the feasibility and efficacy of EUS-HGS through both B2 and B3 simultaneously in seven patients. We decided to perform EUS-HGS through both B2 and B3 to achieve adequate biliary drainage because these two ducts were separate from each other. Here, we report a 100% technical and overall clinical success rate. Early adverse effects were closely monitored. Minimal bleeding was reported in one patient (1/7) and mild peritonitis in one patient (1/7). None of the patients experienced stent dysfunction, fever, or bile leakage after the procedure. EUS-HGS through both B2 and B3 simultaneously is safe, feasible, and effective for biliary drainage in patients with separated ducts. [ABSTRACT FROM AUTHOR]

To investigate the utility of a hand-held digital otoscope for nasal endoscopy and as a pedagogy tool for residents and fellows in patients undergoing external dacryocystorhinostomy (DCR) surgery A digital otoscope (MS450-NTE, Teslong Inc., USA) comprising a digital screen device and a connectible camera probe was used for performing nasal endoscopy. Inspection of nasal cavities was performed pre-, intra-, and post-operatively in sequential patients with nasolacrimal duct obstruction, who underwent DCR or lacrimal probing. Images (1920 × 1080 pixels) and videos (1280 × 720 pixels) were captured. The device was also used for training residents and fellows in performing nasal endoscopy, and to teach basic concepts. The digital otoscope could be used for routine outpatient nasal examination and for performing minor procedures. 53.8% (n = 13) of ophthalmology trainees had never observed nasal endoscopy and 84.6% could not identify more than one major structure correctly prior to the current training. Post-training, all trainees could independently perform nasal endoscopy with the device and 76.9% identified all structures correctly. A digital otoscope with a camera probe is a handy tool for nasal endoscopy and pedagogy. Low-cost gadgets such as this device can effectively be used for performing outpatient nasal endoscopy when expensive endoscopes are unavailable and in peripheral healthcare centers. [ABSTRACT FROM AUTHOR]

False positive radioiodine uptake may pose difficulties in diagnosis and subsequent management of thyroid cancer. Combined imaging techniques, such as SPECT/CT, play a crucial role in accurately identifying the specific location of radioiodine uptake, thereby avoiding potential diagnostic error. This is particularly important in situations where unexpected uptake could lead to unnecessary treatment interventions such as surgery or radioiodine treatment. In this study, we discuss a case involving a 38-year-old female with a history of thyroid cancer and I-131 treatment. Approximately six years later, her course was complicated by left sided epiphora leading to dacryocystorhinostomy and subsequently elevation of thyroglobulin (Tg) levels prompting retreatment by radioiodine. The post-therapy whole-body scan revealed false-positive radioiodine uptake on the left side of the skull, conclusively confirmed through SPECT/CT imaging to be localized in the patient's left eye. [ABSTRACT FROM AUTHOR]

Background: No widely accepted, validated instrument currently exists to measure clinical outcomes in patients who undergo dacryocystorhinostomy (DCR) for treatment of epiphora. Objective: To develop a patient-reported outcome measure applicable to this population. Methods: Psychometric evaluations, consultation with experts, and review of the literature informed item generation of a 12-question questionnaire to incorporate the most relevant symptoms experienced by patients with nasolacrimal duct obstruction. This questionnaire, known as the Tearing Assessment and Rating Scale-12 (TEARS-12), was administered to 32 patients before and after intervention, in the form of endoscopic DCR. Statistical analysis was performed to measure internal consistency, responsiveness, and test-retest reliability. Results: Pre-operative and post-operative TEARS-12 scores (28.2 [standard error (SE) 3.19] vs 11.8 [SE 3.25], respectively, P = 0.001) demonstrated improved patient outcome within 6 weeks following endoscopic DCR. Cronbach's alpha for the questionnaire was 0.90, indicating high overall reliability. Additionally, each question demonstrated internal reliability, with a corrected item-total correlation greater than 0.30. The intraclass correlation between the two pre-operative scores was 0.858 (P < 0.001), indicating high test-retest reliability. Conclusion: TEARS-12 is a statistically valid, easy-to-administer instrument to measure clinical outcomes in patients who undergo endoscopic DCR. [ABSTRACT FROM AUTHOR]

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PurposeMethodsResultsConclusionsTo assess the management of patients with congenital nasolacrimal duct obstruction (CNLDO) in a paediatric population and review the long-term outcomes over a 5-year interval, with particular emphasis on the difference between patients with trisomy 21 and those without trisomy 21.This single-centre, retrospective, cross-sectional, case review study included patients suffering from CNLDO at Alder Hey Children’s Hospital NHS foundation Trust. Patients were divided into two groups: Non-trisomy 21 and trisomy 21. Patients were followed-up for a 60-month interval. Patients aged <12 months at the time of surgery, patients with <60 months of follow-up data and patients with acquired nasolacrimal duct obstruction were excluded. The main outcome measures were discharge rates in patients undertaking primary intervention with syringe and probe (S&P), number of patients requiring further treatment with lacrimal intubation or dacryocystorhinostomy (DCR) and overall symptom-free periods post-treatment.Ninety-three patients (142 eyes) were included. The mean number of surgical interventions was 1.53 ± 0.65. The mean interval between the 1st and 2nd intervention was 15.54 ± 16.33 months. There was a trend towards greater success rates non-trisomy 21 patients versus patients with trisomy 21 (p = 0.1352). The average symptom-free period after the final intervention was 44.31 ± 20.68 months, significantly longer in the non-trisomy 21 group compared to the trisomy 21 group (p = 0.0074).The overall success rate after primary S&P was 55.9%. Our results suggest that in trisomy 21 patients suffering from CNLDO, a one-stage intervention with primary monocanalicular intubation should be considered instead of sequential approach. [ABSTRACT FROM AUTHOR]

Purpose: The study intends to clarify the optimal endoscopic endonasal surgical strategy for symptomatic Rathke's cleft cysts (RCCs). Methods: We retrospectively analyzed patients with RCCs that underwent EEA surgery. The strategy for surgical and reconstruction method selection was presented. Patients were split into groups of fenestration open or closed. Pre- and postoperative symptoms, imaging, ophthalmologic, and endocrinologic exams were reviewed. The incidence of complications and the recurrence rates were determined. Results: The 75 individuals were all received primary operations. The fenestration closed group contained 32 cases, while the fenestration open group contained 43 cases. The median follow-up period was 39 months. The three primary complaints were headache (n = 51, 68.00%), vision impairment (n = 45, 60.00%), and pituitary dysfunction (n = 16, 21.33%). Of the 51 patients with preoperative headaches, 48 (94.12%) reported improvement in their symptoms following surgery. Twenty-three out of 45 patients (51.11%) experienced an improvement in visual impairment. Pituitary dysfunction was found improved in 14 out of 16 individuals (87.50%). There was no discernible difference in the rate of symptom alleviation between both groups. There were three patients (3/75, 4.00%) had cyst reaccumulation. One of them (1/75, 1.33%), which needed reoperation, was healed using pterional approach. In term of complications, cerebral infections occurred in two patients (2/75, 2.67%). Both of them recovered after antibiotic treatment. No postoperative cerebrospinal fluid rhinorrhea occurred. One patient (1/75, 1.33%) in the open group experienced epistaxis. There was no persistent hypopituitarism or diabetes insipidus (DI). Analysis of headache related factors showed that the presence of wax like nodules was related to it. Conclusion: RCC was successfully treated with endoscopic endonasal surgery with few problems when the fenestration was kept as open as feasible. Preoperative identification of T2WI hypointense nodules may be a potential reference factor for surgical indication. [ABSTRACT FROM AUTHOR]

Purpose: To compare the long‐term symptom resolution and use of resources of performing endoscopic dacryocystorhinostomy (enDCR) in acute or delayed phase in patients with acute dacryocystitis (AD). Methods: This prospective, randomised controlled trial was conducted in Helsinki University tertiary Eye and Ear, Nose and Throat (ENT) Hospitals between September 2013 and January 2019. Fifty patients aged 18 and above presenting with AD in the emergency care were randomised into acute and delayed enDCR surgery groups, performed in 1 week or 4 months from the diagnosis of AD. The follow‐up time was 18 months. Outcome measures were subjective epiphora, lacrimal symptoms and visual analogue scale (VAS) pain scores, the number of hospitalised and unhealthy days, use of medication and openness in lacrimal syringing and dye test. Results: EnDCR was performed on 24 patients in the acute and 19 in the delayed group. There were no significant differences between the groups in follow‐up lacrimal symptoms, syringing test, dye test or use of resources. At the 18 months' follow‐up, 21/23 (91.3%) in the acute group and 12/13 (92.3%) in the delayed group had no disturbing lacrimal symptoms. When reoperations and dropouts are considered, beneficial outcome was 22/24 (91.7%) in the acute and 12/16 (75%) (p = 0.195) in the delayed group. The acute group had significantly fewer pain medication days than the delayed group, 3 versus 10.5 (p = 0.03). Conclusion: Acute enDCR is associated with fewer pain medication days and equal resolution of lacrimal symptoms and use of resources. [ABSTRACT FROM AUTHOR]

During the ongoing COVID-19 pandemic, endonasal surgeries for sellar-suprasellar lesions were discouraged due to the risk of transmission of the disease. We reviewed the changes in our management protocol for these lesions as our disease understanding and preparedness evolved. This was a retrospective observational study including patients with sellar-suprasellar and clival lesions presenting to us between March and October 2020. Management protocols were divided into three phases based on the prevalence of the disease and the number of mandatory preoperative COVID-19 tests being conducted. The surgical approach used was analyzed in relation to the preferred approach during pre-COVID times, and surgical outcomes and complications were noted. A total of 31 cases were operated during this period. During Phase I (low prevalence; no preoperative COVID testing) endonasal surgeries were largely abandoned in favor of transcranial approaches. In Phase II (medium prevalence; one preoperative COVID test) we gradually resumed endonasal surgeries for 'emergent' and 'essential' cases, and subsequently in Phase III (high prevalence; two preoperative COVID tests), we had no hesitation in performing 'elective' endonasal surgeries with additional barriers for prevention of aerosol transmission. No patient developed COVID-19 infection postoperatively. Eight HCWs in our department acquired the disease during this period, none of whom were directly involved in the surgeries for the above cohort of patients. With a strict preoperative COVID testing protocol, adherence to proper drilling techniques and using additional barriers to prevent droplet and aerosol spread, endonasal surgeries for sellar-suprasellar lesions are safe during this COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Purpose: This prospective observational study aimed to explore the diversity in lacrimal pathway morphology among patients with congenital nasolacrimal duct obstruction (CNLDO) by examining dacryocystography (DCG) images. Patients and Methods: The study included 64 patients who underwent DCG before undergoing general anesthesia probing for unilateral CNLDO. Several parameters were measured from the lateral view of the DCG images: (1) the lacrimal sac (LS) and the nasolacrimal duct (NLD) angle, (2) the angle formed by the superior orbital rim (SOR), LS, and the NLD, (3) LS length, and (4) bony NLD length. Additionally, frontal views of the DCG images were utilized to measure (5) LS–NLD angle and (6) LS angle concerning the midline. Results: The average age of the patients was 34.3 months. The mean ± standard deviation of the measurements of the above parameters was (1) − 1.2° ± 16.5° (range: − 44.6° ± 46.6°), (2) − 5.0° ± 10.3° (range: − 24.0° ± 19.0°), (3) 10.2 ± 2.4 mm (range: 6.5– 16.0 mm), (4) 8.0 ± 2.5 mm (range: 3.1– 14.8 mm), (5) 15.6° ± 11.2° (range: − 16.8° ± 41.0°), and (6) 15.1 ± 5.2° (range: 3.3°– 29.8°). All parameters, except for parameter (3), conformed to a normal distribution. Conclusion: This study provides valuable anthropometric data derived from DCG images, highlighting the substantial variability in lacrimal pathway morphology among patients with CNLDO. Furthermore, anatomical constraints made probing with a straight metal bougie anatomically infeasible in 25.0% of the patients included in this study. Plain Language Summary: Understanding the morphology of the lacrimal pathway is crucial for the successful probing treatments in patients with congenital nasolacrimal duct obstruction (CNLDO). This study represents an initial effort to quantify anthropometric parameters of the lacrimal drainage system through dacryocystography images, specifically aiming to highlight the limitations of blind probing procedure. The results underscore significant variations in the morphology of the lacrimal drainage system among patients, which could impact diagnostic approaches and treatment strategies. Additionally, the findings suggest that patients with CNLDO who do not respond to blind probing may have underlying anatomical complexities. Therefore, rather than relying on repeated blind probing, employing dacryoendoscopy-guided probing under direct visualization could offer a more effective therapeutic alternative for complicated cases of CNLDO. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate that complicated mucoceles of paranasal sinuses and their clinical presentation, complications of relations with size, destructions areas, extension limits in affected patients. Materials and methods: A retrospective review was performed on patients who were diagnosed and treated as paranasal sinus mucoceles at ENT department from 2002 to 2013 years. Patients' demographic data, mucoceles location, symptoms, surgical approach and complications were evaluated. Results: The study group included 9 male and 10 female patients with a mean age of 45,0 years (range, 12–76 years). This case series include fronto-ethmoidal complex (52,6%), followed by frontal (26,3%), maxillary (15,7%) and sphenoid sinus mucoceles (5,2%). Endoscopic sinus surgery (ESS) was performed on 11 patients (57.8%); endoscopic procedures included marsupialization through an infundibulotomy, associated with an anterior ethmoidectomy and maxillary sinus antrostomy. Four patients (21%) underwent an external surgical procedure. 8 patients (42%) were treated by a combination of both endoscopic and external approaches such as trephination of the anterior wall of the frontal sinus, osteoplastic flap approach, Caldwell-Luc operation, anterior craniotomy and Lynch procedure. Complications occurred only in 2 cases (10.5%). Conclusion: The majority of patients with extensive paranasal sinus mucoceles exhibited ophthalmologic and intracranial symptoms. A satisfactory outcome can be achieved after surgical treatment of both endoscopic and external approaches. [ABSTRACT FROM AUTHOR]

Purpose: To study the outcomes of balloon dacryoplasty (BD) or (BDCP) in children with persistent congenital nasolacrimal duct obstruction (pCNLDO) by using new and reused balloon catheters. Methods: Our retrospective analysis focused on managing pCNLDO by using the BD or BDCP technique. The study included children aged >1 year to <12 years who underwent single or multiple probings before. Our specific lacrimal workup included a detailed history and examination, as published earlier. We used conventional, straight, 2 mm × 13 mm/3 mm × 15 mm lacrimal balloons (FCI, Ophthacath). We have described a technique to use the same catheter for three BD procedures (1 new + 2 reuse). The outcomes were categorized as complete success, partial success, and failure. The minimum follow‑up of each child was 6 months. Results: We analyzed 64 children (89 eyes) with a mean age of 58 months (15–132 months). All children (100%) had epiphora with discharge and positive FDDT. All children underwent BD under general anesthesia – new balloons in 59 eyes and reused balloons in 30 eyes. The balloons were plasma sterilized akin to vitrectomy cutters and tubings of phaco machines. We noted three leaks from reused balloons (2 from the balloon tip and 1 from the plastic hub). At a mean follow‑up of 14.5 months, complete success was noted in 77 eyes (86.5%) (52 new and 25 reuse), while 8 eyes had partial success (8.9%) (4 new and 4 reuse). Failure of BD was noted in four eyes (4.5%) (3 new and 1 reuse). None had significant complications with new or reused balloons. Conclusion: BD or BDCP is a quick, safe, easy, and effective procedure that resolves pCNLDO symptoms satisfactorily. Carefully reusing a conventional balloon catheter is possible with comparable efficacy and no additional complications in pCNLDO. [ABSTRACT FROM AUTHOR]

Background and Purpose: to compare the results of probing alone versus primary silicone intubation in cases of complex congenital NLDO. Methods: The study was done in ophthalmology department, Zagazig university hospitals from May 2022 to December 2023. Patients with complex CNLDO in children aged 1 - 4 years were included. We excluded cases of simple CNLDO, failed previous probing or intubation. Patients were divided randomly into two groups. The first group (group I) (32) eyes were treated with intubation and the second group (group II) (32) eyes were treated with probing and syringing. Results: 64 patients with complex type of CNLDO were enrolled. There was no significant difference between both groups regarding age (P = 0.990) and gender (P = 0.448). Failure rates were significantly higher in group II than in group I at one week (40.6 percent vs. 15.6 percent, P = 0.026). The results remained constant at the first and third month postoperative in which the failure rates at group II vs group I were (56.3 % vs. 15.6 %, P 0.001), and the results were also the same at the fourth and sixth month with the failure rates at group II vs group I were (68.8 % vs 15.6 %, P 0.001). Conclusion: Primary silicone intubation is recommended in cases of complex CNLDO because it produces better results than probing and has a longer success rate. [ABSTRACT FROM AUTHOR]

Background: Data from patients with post‐ablative dural defects reconstructed using a free temporalis muscle fascia graft (FTFG) after resection of anterior or central skull base tumors were retrospectively analyzed. Methods: The primary predictor and outcome variables were the reconstructive methods for dural repair and postoperative cerebrospinal fluid (CSF) leakage rate, respectively. Results: Eighty patients were included, and 94 postoperative dural reconstructions were performed using FTFG. The postoperative CSF leakage rate was 3.19%. The postoperative CSF leakage rates did not significantly differ between open and endonasal endoscopic surgeries (1.92% vs. 4.88%; p > 0.05). In cases completed using the endonasal endoscopic approach, the postoperative CSF leakage rate was significantly associated with the intraoperative CSF leak flow (p < 0.05). Conclusions: Post‐ablative dural defect reconstruction using FTFG resulted in low postoperative CSF leakage and complication rates comparable to those of free fascia lata graft from available literature. [ABSTRACT FROM AUTHOR]

AIM: To compare the success rate and complications of adjuvant use of mitomycin C and triamcinolone- impregnated biodegradable nasal packing (TABP) in endoscopic dacryocystorhinostomy (DCR). And to evaluate the efficacy of combining intraoperative mitomycin C and TABP for endoscopic DCR. METHODS: A total of 198 eyes of 148 patients who underwent endoscopic DCR for acquired nasolacrimal duct obstruction were retrospectively analysed. The patients were randomly divided into three groups: Group A included patients treated without intraoperative mitomycin C but with TABP, Group B included patients treated without triamcinolone but with intraoperative mitomycin C and normal saline-impregnated nasal packing, and Group C included patients treated with intraoperative mitomycin C and TABP. RESULTS: The results revealed no significant difference in the overall success rates between Groups A (86.8%) and B (89.2%; P=0.377). However, Group C (97.5%) showed a significantly higher overall success rate than Groups A and B. The incidence of granulomas was significantly lower in group C (5%) than in Groups A (20.8%) and B (15.2%; P=0.009). Other complications, such as crust, synechiae, and revision surgery, did not differ significantly among the three groups. CONCLUSION: The combination of intraoperative mitomycin C and TABP effectively prevents granulomas and enhances surgical success rate. Additionally, there is no statistically significant difference observed between the use of mitomycin C or TABP alone.

AIM: To investigate the effect of unilateral endoscopic dacryocystorhinostomy on binocular surface indexes.METHODS: Totally 45 cases with monocular primary acquired nasolacrimal duct obstruction(PANDO)who successfully underwent endoscopic dacryocystorhinostomy between 1 December 2022 and 31 July 2023 were enrolled in the study. Ocular surface indexes, including the non-invasive tear break-up time(NIBUT), Sjögren's International Collaborative Clinical Alliance ocular staining score(SICCA OSS), Korb score of lid wiper and Schirmer test scores, were collected preoperatively and at 0.5, 1 and 3 mo post-operatively. Subsequently, various indexes were compared at each time point between the operated and healthy eyes pre- and post-operatively.RESULTS: There was no significant differences between operated and healthy eyes in NIBUT, SICCA OSS, Korb scores and Schirmer test(all P>0.05). Furthermore, the Korb scores of operated eye at 0.5, 1 and 3 mo post-operatively were significantly lower than the preoperative value(P=0.034, 0.044, 0.027). Moreover, the Schirmer test score of the operated eye at 1 mo post-operatively was significantly lower than the preoperative value(P=0.0461).CONCLUSION:After a successful endoscopic dacryocystorhinostomy, tear drainage is restored, however, ocular surface damage worsens. These changes typically peak at 1 mo post-operatively before gradually improving.

Background: Biliary obstruction due to compression by a B-cell solid tumor occurs rarely. A few reports have described biliary reconstruction surgery for obstructive jaundice caused by Burkitt's lymphoma. However, there are no detailed reports on pediatric cases. We report a pediatric case of obstructive jaundice due to malignant lymphoma treated with biliary reconstruction surgery. Case presentation: A 5-year-old girl presented to our hospital with a massive abdominal tumor that caused biliary stricture. Chemotherapy was initiated after an open tumor biopsy. However, endoscopic biliary stent placement was performed owing to elevated bilirubin levels. We treated the patient with chemotherapy for 9 months while endoscopically replacing the biliary stent every few months. She achieved complete tumor remission. However, sclerotic lymph nodes were persistent on the dorsal side of the cholecystic duct junction, and biliary stricture at the same site had changed to stent-dependent biliary obstruction. Therefore, we performed choledochojejunostomy and retrocolic Roux-en-Y reconstruction 15 months after initial admission. There were no postoperative complications or tumor recurrences, and the bilirubin level remained low. Histopathologically, the resected bile duct wall was fibrotic and thick, and the bile duct lumen narrowed. Conclusions: Biliary reconstruction is effective to achieve long-term biliary patency in pediatric patients with stent-dependent biliary obstruction due to malignant lymphoma. However, the decision on when to stop biliary stent replacement and proceed to biliary reconstruction surgery is a matter of debate. Further case studies are required to address this issue. [ABSTRACT FROM AUTHOR]

Background: Craniopharyngiomas (CPs) are generally derived from the craniopharyngeal duct epithelium, accounting for 38% and 24.5% of mortality in pediatric and adult patients, respectively. At present, the widespread application of the endoscopic endonasal transsphenoidal approach (EEA) has led to controversy between the traditional microscopic transcranial approach (TCA) and EEA in relation to the surgical management of CPs. Object and method: We performed a systematic review and meta-analysis comparing the complications, surgical outcomes, and endocrine functions of patients with CPs to provide evidence-based decision-making in their surgical management. Result: Overall, 11 observational studies with 12,212 participants were included in the meta-analysis, in which five of them only included an adult population, three of them only included a child population, and the other three studies included a mixed population (adult and child). In pediatric patients, the EEA achieved a higher gross total resection (GTR) rate (odds ratio (OR) = 5.25, 95%CI: 1.21–22.74), lower recurrence rate (OR = 0.54, 95%CI: 0.31–0.94, p = 0.030), and less hypopituitarism (OR = 0.34, 95%CI: 0.12–0.97, p = 0.043). In adult patients, EEA significantly improved mortality (OR = 0.09, 95%CI: 0.06–0.15, p < 0.001) and visual outcomes (visual improvement: OR = 3.42, 95%CI: 1.24–9.40, p = 0.017; visual deficit: OR = 0.30, 95%CI: 0.26–0.35) with decreases in postoperative stroke (OR = 0.58, 95%CI: 0.51–0.66, p < 0.001), hydrocephalus, and infections (OR = 0.32, 95%CI: 0.24–0.42, p < 0.001). Conclusion: Compared with the traditional TCA in primary CP resection, the development and wide application of EEA optimistically decreased the recurrence rate of CP, alleviated hypopituitarism with improvement in the GTR rate of pediatric patients, and significantly improved the visual outcomes, hydrocephalus, postoperative stroke, survival, and infection rates of the patients. Therefore, EEA is an optimal approach for primary CP resection. [ABSTRACT FROM AUTHOR]

Context: The prognosis of combined septoplasty and endoscopic dacryocystorhinostomy (En-DCR) for moderate nasal septum deviation (NSD) has not yet been fully investigated. Purpose: To evaluate whether septoplasty improves the prognosis of En-DCR for moderate NSD. Settings and Design: A retrospective cohort study in a real-world clinical setting. Methods: The postoperative FICI DCR ostium grading scores and functional and anatomical information at 1, 2, 3, and 6 months were determined for consecutive patients with chronic dacryocystitis (CD) and moderate NSD who underwent En-DCR. Statistical Analysis Used: Univariate and generalized estimating equation multivariate analyses were used to compare the outcomes of the septoplasty and non-septoplasty groups. Results: En-DCR and septoplasty were concurrently performed for 32 (20.1%, 32/158) cases. The total FICI DCR ostial scores for the septoplasty and non-septoplasty groups were highest at the first (4.97 ± 0.177 vs. 4.97 ± 0.176, P > 0.05) and lowest at the sixth (4.41 ± 1.341 vs. 4.50 ± 1.355, P > 0.05) postoperative months. At the end of follow-up, the two groups showed comparable proportions of pa;tients requiring definitive intervention for the ostium (6.3% vs. 7.1%, P > 0.05), comparabe functional success rates (87.5% vs. 90.5%, P > 0.05) and anatomical success rates (93.8% vs. 92.9%, P > 0.05). Only the non-septoplasty group experienced nasal mucosal adhesions (3.2%, 4/126). Conclusions: In patients with CD and moderate NSD, nasal septoplasty did not impact En-DCR prognosis, but reduced the complications. Skilled surgeons should reconsider septoplasty in the absence of otolaryngological indications. [ABSTRACT FROM AUTHOR]

Background: A common complication of bicanalicular intubation is dislocation of the silicone tube. Methods: Eleven patients with prolapsed silicone tubes who had undergone bicanalicular nasal intubation were injected with a 2 per cent lidocaine solution to infiltrate the lacrimal duct mucosa. A memory wire probe was used to pull a 4-0 suture through the lacrimal passage retrogradely, allowing the suture to grab the silicone tube. Paraffin oil was applied to the contact part of the rope and the silicone tube, then the distal end of the silk thread was removed from the nostril until the tube was pulled into place. Results: The prolapsed silicone tubes were restored by surgery in nine patients, with the drainage tube in the correct position in the eye and the lacrimal duct irrigation unobstructed. Conclusion: The optimisations made in this study are considered effective adjustments of reduction surgery for a prolapsed silicone tube. [ABSTRACT FROM AUTHOR]