title: Prevention of re-obstruction in watery eye treatment: three-flap technique in external dacryocystorhinostomy.
abstract: OBJECTIVE
  To examine the surgical outcome of three-flap external dacryocystorhinostomy (3-flap ex-DCR) based on the most common site of granulation occurrence in no-flap endonasal DCR (no-flap en-DCR).
  
  
  METHODS
  This was a retrospective observational study. We first examined the location of granulation occurrence in the osteotomy site using nasal endoscopy after no-flap en-DCR on 53 sides of 37 patients (5 male, 32 female) with nasolacrimal duct obstruction. Based on the results of this surgery, we performed 3-flap ex-DCR on 70 sides of 61 patients (18 male, 43 female) with nasolacrimal duct obstruction. Anatomical success was defined as no reflux under lacrimal irrigation and a patent osteotomy site under nasal endoscopic examination at postoperative 12 months. Functional success was defined as no symptoms of watery eyes over the same period.
  
  
  RESULTS
  In the no-flap en-DCR patients, the granulation was formed in 42 sides (79.2 %): 18 sides (34.0 %) on the superior portion, 9 sides (17.0 %) on the inferior portion, 35 sides (66.0 %) on the anterior portion, and only 1 side (1.9 %) on the posterior portion, which was very small. Based on these results, we performed the 3-flap ex-DCR with the anterior, superior, and inferior flaps. Anatomical success with this technique was achieved in all sides (100 %), and functional success was obtained in 66 of 70 sides (94.3 %).
  
  
  CONCLUSIONS
  The 3-flap ex-DCR did not cause recurrent nasolacrimal duct obstruction, rendering it a very useful technique in terms of quality of life and medical economics.
authors: Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, 480-1195, Japan. cosme@d1.dion.ne.jp.
authors: Hirohiko
authors: H
authors: Kakizaki
authors: Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, 480-1195, Japan.
authors: Yoshiyuki
authors: Y
authors: Kitaguchi
authors: Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, 480-1195, Japan.
authors: Yasuhiro
authors: Y
authors: Takahashi
authors: Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, 480-1195, Japan.
authors: Jacqueline
authors: J
authors: Mupas-Uy
authors: Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, 480-1195, Japan.|Ide Eye Hospital, Yamagata, Japan.
authors: Hidenori
authors: H
authors: Mito
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003608:Dacryocystorhinostomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006097:Granulation Tissue / Q000473:pathology*; D006801:Humans; D007767:Lacrimal Duct Obstruction / Q000628:therapy*; D008297:Male; D008437:Maxilla / Q000601:surgery; D008875:Middle Aged; D009301:Nasolacrimal Duct / Q000601:surgery*; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009666:Nose; D010027:Osteotomy / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis*; D012008:Recurrence; D012189:Retrospective Studies; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome
keywords: Granulation; No-flap endonasal dacryocystorhinostomy; Re-obstruction; Three-flap external dacryocystorhinostomy