title: Factors associated with rhinostomy shape after endoscopic dacryocystorhinostomy.
abstract: OBJECTIVE
  To determine the factors associated with rhinostomy shape after endoscopic dacryocystorhinostomy (DCR) in patients with primary acquired nasolacrimal duct obstruction.
  
  
  METHODS
  Retrospective comparative study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  One hundred and two cases in 70 patients were included in the study.
  
  
  METHODS
  All cases were classified into three groups according to the healed appearance of the rhinostomy: flat, ladle and ice scoop type. The flat shape was characterised by an opening with a flat surrounding and no clear border between the lacrimal sac and the nasal mucosa. The ladle shape had a depressed base without markings of a lacrimal sac. The ice scoop shape had a depressed base with a clear border between the lacrimal sac and the nasal mucosa. Anatomic success was defined as patency with syringing and endoscopic evidence of ostial patency. Functional success was defined as visualisation of fluorescein dye at the ostium and relief from epiphora. Clinical information and intra- and postoperative endoscopic video findings were compared between the three groups.
  
  
  RESULTS
  Of the 102 cases, 19 flat, 37 ladle and 46 ice scoop type rhinostomies were observed during the follow-up examinations. Among the variables studied, patient demographics and rhinostomy size and location did not differ between the three groups. However, intraoperative lacrimal sac findings (sac size, wall thickness and mobility), postoperative ostial shrinkage and rhinostomy movement were associated with postoperative rhinostomy shape (all P < 0.05). With regard to surgical outcomes, there were no differences in anatomical patency between the three groups. However, the flat group had a worse functional success rate (73.7%) than the ladle (91.9%) and ice scoop (97.8%) groups (P = 0.008). A higher degree of ostial shrinkage and poor rhinostomy movement was observed with the flat shape appearance, which had a small, thick and poorly mobile lacrimal sac.
  
  
  CONCLUSIONS
  Lacrimal sac characteristics play a prominent role in determining rhinostomy shape after endoscopic DCR. The rhinostomy shape, along with the degree of ostial shrinkage and rhinostomy movement, is predictive of functional success after endoscopic DCR.
authors.affiliation: Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: H J
authors.initials: HJ
authors.lastname: Shin
authors.affiliation: Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: K I
authors.initials: KI
authors.lastname: Woo
authors.affiliation: Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Y-D
authors.initials: YD
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D003608:Dacryocystorhinostomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007767:Lacrimal Duct Obstruction / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity; D009301:Nasolacrimal Duct / Q000000981:diagnostic imaging / Q000601:surgery*; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D011184:Postoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome