title: An easy method for intraoperative confirmation of lacrimal sac patency in endoscopic dacryocystorhinostomy.
abstract: OBJECTIVE
  Few studies have focused on the intranasal localization of the lacrimal sac during endoscopic dacryocystorhinostomy: landmarks in order to find the medial wall of the lacrimal sac have been described, but there is a lack of description of methods for the verification of the complete marsupialization of the lacrimal sac during surgery. In this report, we propose an easy and effective method for certain intraoperative identification of lacrimal sac.
  
  
  METHODS
  A method in order to verify the effective marsupialization of the lacrimal sac is applied and described: to ensure that the opening of the sac in the nasal cavity is complete, the surgeon should identify the Rosenmuller valve, which is the end of the common canaliculus in the lacrimal sac. Continuous irrigation with saline solution through the inferior canaliculus can be useful to obtain a clean surgical area and to permit easy intraoperative identification of the valve.
  
  
  RESULTS
  Between 2007 and 2015, 193 endoscopic dacryocystorhinostomies were performed in our institutions. Postoperative surgical success at last follow-up (minimum 12 months) was 93.8% (181 out of 193 of cases). No major complications were observed.
  
  
  CONCLUSIONS
  Correct and complete exposure of the lacrimal sac during surgery is crucial for a good outcome: when the opening of the common canaliculus is identified, the surgeon is assured that the sac has been correctly and completely marsupialized inside the nasal cavity.
authors.affiliation: Department of Otorhinolaryngology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Pavia - Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Pagella
authors.affiliation: Department of Otorhinolaryngology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Pavia - Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pusateri
authors.affiliation: Department of Otorhinolaryngology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Pavia - Italy.
authors.forename: Elina
authors.initials: E
authors.lastname: Matti
authors.affiliation: Department of Otorhinolaryngology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Pavia - Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Carena
authors.affiliation: Department of Otorhinolaryngology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Pavia - Italy.
authors.forename: Luis
authors.initials: L
authors.lastname: Quiroa
authors.affiliation: Department of Ophthalmology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Pavia - Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Antoniazzi
authors.affiliation: Department of Otorhinolaryngology and Otologic Surgery, Azienda Ospedaliera - Policlinico of Padova, University of Padova, Padova - Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Emanuelli
mesh_terms: D003608:Dacryocystorhinostomy / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D007432:Intraoperative Period; D007765:Lacrimal Apparatus / Q000000981:diagnostic imaging* / Q000601:surgery; D012189:Retrospective Studies