HOLMIUM - YAG ENDONASAL LASER DACRYOCYSTORHINOSTOMY

Previously described techniques of endonasal laser-assisted dacryocyst orhinostomy appear to offer several advantages over conventional exter nal dacryocystorhinostomy, including the following: (1) decreased disr uption of medial canthal anatomy, (2) enhanced hemostasis, and (3) avo idance of a cutaneous scar. Although good results were achieved, sever al limitations of early laser-assisted techniques have been noted, inc luding difficulty in removal of the thick bone of the anterior lacrima l crest and inability to obtain specimens of lacrimal sac mucosa for b iopsy purposes. In a series of 40 consecutive, primary endonasal dacry ocystorhinostomy procedures, we used the holmium:YAG (Ho:YAG) laser fo r bone removal and endoscopic sinus surgical instrumentation to obtain lacrimal sac biopsy specimens. Intraoperative hemostasis was excellen t and medial canthal scarring was avoided in all patients. The overall long-term ostium patency rate in our series was 82%. Several technica l modifications adopted in the latter part of our series, including us e of a small drill for supplemental bone removal, extensive removal of lacrimal sac mucosa, and use of a double stent, appeared to enhance t his success rate.