Nasal mucosal flap repositioning technique in endonasal endoscopic dacryocystorhinostomy- a prospective interventional study

Endoscopic dacryocystorhinostomy (DCR) is an established procedure performed for the treatment of chronic dacryocystitis with epiphora due to blocked nasolacrimal duct. From September 2019 to February 2021, 40 endoscopic DCRs were performed. The objective was to study the technique involved in repositioning of nasal mucosal flap with lacrimal sac mucosa in endoscopic endonasal DCR. Preoperative work-up included ROPLAS test, irrigation of lacrimal pathway and nasal endoscopy. The surgical technique comprises of repositioning the nasal mucosal flaps with lacrimal sac mucosa in all cases. Serial monthly follow-up concluded that 38 patients (95%) who underwent surgery had patent lacrimal pathway with no epiphora. 39 patients (97.5%) had healthy nasal cavity at 6 months follow-up with no synechiae. Post-operative follow-up included nasal endoscopy and lacrimal irrigation to evaluate anatomical patency. Repositioning the nasal mucosal flaps over lacrimal sac mucosa has come to deliver better functional results in a long term by its ability to cause fibrosis and faster healing, eventually creating a patent pathway.