ENDONASAL IMPLANTATION OF SILICON FOIL IM PROVES THE RESULTS OF REVISIONAL SURGERY OF THE NASOLACRIMAL APPARATUS IN DACRYORESTENOSIS

Background Uncomplicated dacryocystorhinostomy after dacryocystitis wi th lacrimal sac obstruction has a successrate of 85%. However therapy of restenosis poses a problem. Vast destruction of lacrimal and nasal mucosa renders the drainage system susceptible for further stenosis. T his article presents a new surgical procedure for the treatment of res tenosis of the nasolacrimal apparatus. The major difference from other techniques is the endonasal implantation of a silicon foil. This coun ters the development of synechiae and promotes the epitheliasation of wound surfaces. As a result the nasal mucosa can easier gain access to lacrimal mucosa. A complete mucosal coating of the reconstructed lacr imal drainage system is an important condition for the sufficient drai nage of the tear-film. Patients and Methods In 30 patients with resten osis after one or multiple dacryocystorhinostomies a silicon foil was implanted endonasally as part of their surgical revision. After skin i ncision and removal of scar tissue the bony ostium was enlarged. The c analiculi were intubated with silastic tubing. Afterwards the endonasa l synechiae were split and a 0.2-0.4 mm silicon foil was implanted end onasally und fixed. The silastic tubing was brought through a hole in the silicon foil and knoted inside the nose. Then the wound was closed . Postoperative evaluation of the surgical success ranged from 3 to 36 months (mean 16 months). Results The postoperative result was good in 24 patients. Sixteen patients were without symptoms, 8 had epiphora o nly on stress. The latter felt their situation to be greatly improved. The long-term results were directly proportional to the amount of rec onstructable mucosa and inversely proportional to the severity of cana liculus damage. Adverse reaction to the silicon foil were not noted. C onclusion Endonasal implantation of a silicon foil is a new, easy and successful technique for the treatment of endonsal synechiae and reste nosis of the nasolacrimal apparatus.