title: Piezosurgery in External Dacryocystorhinostomy.
abstract: BACKGROUND
  Dacryocystorhinostomy (DCR) can be performed via an external or endoscopic approach. The use of ultrasonic or piezosurgery has been well described for endoscopic DCRs but is lacking for external DCRs. This study presents a case series of external DCRs performed using piezosurgery evaluating results and complications.
  
  
  METHODS
  Prospective, consecutive case series of patients undergoing primary external DCR for lacrimal drainage insufficiency. A standard external DCR technique was used using 1 of 2 piezosurgery systems for all bone incision. All patients received silicone intubation to the lacrimal system. Surgical outcome was measured in terms of patient-reported epiphora as follows: 1) complete resolution, 2) improvement >50%, 3) improvement <50%, and 4) No improvement. Intra and postoperative complications were also recorded.
  
  
  RESULTS
  Fifty-two patients, 14 male and 38 female, were included in the study, with 2 patients having bilateral surgery. The average age of the patients was 55.8 years. The average length of follow up was 221 days. Surgical outcomes showed 72% of patients with complete resolution of epiphora and 21% with >50% improvement. There were 4 patients (7%) who had <50% improvement. There was 1 (2%) intraoperative complication and 2 (4%) postoperative complications recorded.
  
  
  CONCLUSIONS
  Piezourgery is a viable modality for performing external DCRs. The lack of surgical complications shows a potential for decreased soft tissues damage. The surgical success rate based on patient-reported epiphora is similar to those published for mechanical external DCRs. This modality may benefit the novice surgeon in the reduction of soft and mucosal tissue damage.
authors.affiliation: *Section Oculofacial Plastic and Reconstructive Surgery, Ohio University/Doctor's Hospital, Columbus, Ohio, †Department of Ophthalmology, Oral and Maxillofacial Surgery, OhioHealth Grant Medical Center, Columbus, Ohio, ‡Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina, and §Department of Ophthalmology, Ohio State University, Columbus, Ohio, U.S.A.
authors.forename: Craig N
authors.initials: CN
authors.lastname: Czyz
authors.forename: Amy M
authors.initials: AM
authors.lastname: Fowler
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Dutton
authors.forename: Kenneth V
authors.initials: KV
authors.lastname: Cahill
authors.forename: Jill A
authors.initials: JA
authors.lastname: Foster
authors.forename: Robert H
authors.initials: RH
authors.lastname: Hill
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Everman
authors.forename: Cameron B
authors.initials: CB
authors.lastname: Nabavi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003608:Dacryocystorhinostomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007440:Intubation / Q000379:methods; D007766:Lacrimal Apparatus Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009301:Nasolacrimal Duct / Q000601:surgery*; D059745:Piezosurgery / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D015607:Stents; D055815:Young Adult