The importance of lacrimal diaphragm and periosteum suturation in external dacryocystorhinostomy.
OBJECTIVE
To evaluate retrospectively the cosmetic and functional effects on success of lacrimal diaphragm and periosteum suturation after the anastomosis of anterior flaps before skin closure in external dacryocystorhinostomy (ext-DCR).


METHODS
During ext-DCR, lacrimal diaphragm was separated from periosteum over anterior lacrimal crest before entering lacrimal fossa. At the end of ext-DCR, the separated periosteum and lacrimal diaphragm were sutured in the study group (270 patients) and were left unsutured in the age-matched control group (96 patients). The effects of this approach on postoperative appearance of incision area at the 6-month postoperative controls, and functional success (assessed by fluorescein disappearing test) and anatomical success rates (assessed by lacrimal syringing) at the 12-month postoperative controls were evaluated.


RESULTS
The anatomic success rate between the 2 groups were found to be similar (94.8% and 92.7% in the study and control groups, respectively, p = 0.447). Fluorescein disappearing test was detected to be normal in 246 patients (91.1%) and 78 patients (81.2%) in the study and control groups, respectively (p = 0.009). Postoperative skin scar was found to develop significantly greater in the control group (p = 0.001). Significant hypertrophic scar was seen in 3 patients (1.1%) and 8 patients (8.3%) in the study and control groups, respectively. No epicanthal fold or webbing occurred in the study group.


CONCLUSIONS
The preservation of the lacrimal sac wall's attachments at the end of ext-DCR to the medial canthal tendon, orbicularis oculi muscle, and lacrimal diaphragm allows the lacrimal pump to function more effectively. Ext-DCR with suturation of the periosteum and lacrimal diaphragm method may provide an excellent functional and aesthetic outcome in the majority of patients.
Ophthalmology Department, Yeditepe University, Istanbul, Turkey. fciftci@yeditepe.edu.tr
Ferda
F
Ciftci
Umut Asli
UA
Dinc
Vildan
V
Ozturk
D000714:Anastomosis, Surgical; D000768:Anesthesia, General; D000779:Anesthetics, Local / Q000008:administration & dosage; D003608:Dacryocystorhinostomy; D003964:Diaphragm / Q000601:surgery; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009301:Nasolacrimal Duct / Q000601:surgery*; D010521:Periosteum / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps
D000779:Anesthetics, Local; D008012:Lidocaine