title: Improving outcomes by combining septoplasty with primary external dacryocystorhinostomy.
abstract: OBJECTIVE
  External dacryocystorhinostomy (EXT-DCR) is the gold standard in the treatment of acquired nasolacrimal duct obstruction. Intranasal pathology can compromise the success of primary and revision external dacryocystorhinostomy EXT-DCR procedures. Nasal septal deviations resulting in unfavorable anatomy are an identified cause of DCR failures. In this study, we examine the causes of failure in our patient population and propose that concomitant treatment of septal deviations at the time of primary EXT-DCR can decrease the rate of revision surgery.
  
  
  METHODS
  Retrospective review of patients who had undergone an EXT-DCR.
  
  
  RESULTS
  Over a five year period, 12 EXT-DCR failures were identified and 8 were directly attributable to nasal septal deviations. Revision surgery was successful in all 8 cases after correction of the nasal septal deviation. A second cohort of patients was identified who had undergone primary EXT-DCR and septoplasty concomitantly. Eight consecutive patients underwent the combined procedure for a total of 10 EXT-DCR and 8 septoplasties. The only failure was due to a common canalicular obstruction (90% success rate for the combined approach).
  
  
  CONCLUSIONS
  As a result of our findings, we believe that treating nasal septal deviation at the time of the initial surgery can help minimize the need for revision surgery.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: David M
authors.initials: DM
authors.lastname: Chan
authors.affiliation: Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Iuri
authors.initials: I
authors.lastname: Golubev
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, IN. Electronic address: tshipcha@iupui.edu.
authors.forename: Taha Z
authors.initials: TZ
authors.lastname: Shipchandler
authors.affiliation: Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN; Oculofacial Plastic and Orbital Surgery, Indianapolis, IN.
authors.forename: William R
authors.initials: WR
authors.lastname: Nunery
authors.affiliation: Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN; Oculofacial Plastic and Orbital Surgery, Indianapolis, IN.
authors.forename: H B Harold
authors.initials: HB
authors.lastname: Lee
mesh_terms: D003608:Dacryocystorhinostomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000601:surgery*; D009300:Nasal Septum / Q000002:abnormalities / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome