title: Endoscopic dacryocystorhinostomy: the keys to surgical success.
abstract: OBJECTIVE
  To describe a surgical technique for endoscopic endonasal dacryocystorhinostomy.
  
  
  METHODS
  A consecutive case series of adult endoscopic dacryocystorhinostomy surgery was reviewed. The specific surgical approach of uncinectomy with or without septoplasty and anterior middle turbinectomy was noted. Postoperative follow up including endoscopic examination and results were documented.
  
  
  RESULTS
  A total of 300 cases were included (271 patients) with average age of 66 (range 24-94). An uncinectomy was performed in 285 of 300 (95%) cases, a septoplasty in 82 of 300 (27%) cases and an anterior middle turbinectomy performed in 225 of 300 (75%) cases. Postoperative bleeding that required nasal packing occurred in 2 of 300 (0.6%) cases. Persistent nasolacrimal symptoms after surgery occurred in 18 of 300 (6.0%) cases with an average follow up of 28 months (range 1-70). Postoperative nasolacrimal symptoms were attributed to a persistent lacrimal sac (sump syndrome) in 1 of 300 (0.3%) cases, a mucocele recurrence in 2 of 300 (0.6%) cases, and scarring at the rhinostomy in 15 of 300 (5.0%) cases.
  
  
  CONCLUSIONS
  Endoscopic endonasal dacryocystorhinostomy is an effective treatment for nasolacrimal duct obstruction. An uncinectomy, septoplasty, and anterior middle turbinectomy contribute to the optimal clearance of the common canaliculus and ultimate surgical success.
authors.affiliation: *Department of Ophthalmology, Hôtel-Dieu de Paris, University of Paris, VI-Medical School, Paris, France; †Division of Ophthalmology, The Children's Hospital of Philadelphia and the University of Pennsylvania; ‡ENT, Clinique Saint-Jean-de-Dieu, Paris, France; and §Edouard Herriot Hospital, Place D'arsonval 69 003 Lyon.
authors.forename: Bruno
authors.initials: B
authors.lastname: Fayet
authors.forename: William R
authors.initials: WR
authors.lastname: Katowitz
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Racy
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Ruban
authors.forename: James A
authors.initials: JA
authors.lastname: Katowitz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003608:Dacryocystorhinostomy / Q000379:methods*; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009301:Nasolacrimal Duct / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult