Treatment of chronic dacryocystitis in children
A comparative analysis was conducted of two surgical techniques involving both external and intranasal approaches. A total of 122 dacryocystorhinostomies were performed in children aged 3 to 15 years: 24 external and 98 endonasal. Due to low rates of traumatic injury and short duration of surgical intervention during endonasal approach, we carried out dacryocystorhinostomy concomitantly on both sides when necessary (in six cases). No bilateral surgery involving external dacryocystorhinostomy was performed. In two cases dacryocystitis was exacerbated by the presence of lacrimal sac fistula. In both cases post endonasal dacryocystorhinostomy resulted in spontaneous repair of fistula on the 6th/7th day. Endonasal dacryocysterhinostomy was successfully performed in three cases in patients with aggravation of lacrimal sac phlegmon. Cicatrical keloids tended to form during external dacryocystorhinostomy in seven (20%) patients while the cosmetic effect was maximal with endonasal surgery. Endonasal approach offers a host of advantages : the possibility of its being carried out during the acute period of inflammation; anatomical features of the nasal cavity can be assessed and corrected during surgery; plasty of anastomosis between the lacrimal sac and the nasal cavity is a possibility; creation of funnel shaped osseous "window"; ease of restoring normal tear outflow if a relapse occurs; the possibility of concurrently conducting bilateral surgery on the lacrimal passages, eyelids and orbital cavity; provision of preventive care should nose bleeding occur.