Term
| When is a Dacryocystorhinostomy (DCR) performed? |
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Definition
| When the naso-lacrimal duct is obstructed by fibrous tissue or bone and has become impermeable to establish a new communication pathway between the lacrimal sac and the nose. |
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Term
| What position is the patient in for a Dacryocystorhinostomy? |
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Definition
| Supine, table in reverse trendelenburg position; padded footboard used and head positioned with the face turned slightly away from the surgeon |
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Term
| What type of Anesthesia is used during a Dacryocystorhinostomy? |
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Definition
| First administration of local then general is induced. |
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Term
| Why is general Anesthesia used for a Dacryocystorhinostomy? |
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Definition
| Because the procedure is often long and tedious due to considerable bleeding and the resultant time needed to achieve hemostasis. |
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Term
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Definition
| Used to minimize bleeding during Dacryocystorhinostomy |
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Term
| What local anesthetic is used and where is it instilled? |
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Definition
| Tetracaine 1% WITH EPINEPHRINE 1:5000, two drops. This is instilled into the conjunctival sac. |
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Term
| Where is Lidocaine 2% epinephrine injected? |
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Definition
| At the beginning of the lacrimal crest, and sprayed into the anterior third of the nasal meatus. (lidocaine is also injected into the mucoperiosteum after the insertion of a nasal speculum. |
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Term
| What is achieved by using a Kerrison Rongeur? |
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Definition
| The anterior lacrimal crest to the entrance of the naso-lacrimal duct is removed. |
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Term
| What precautions need to be made if using a small oscillating saw to make an ostium? |
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Definition
| The eyelids need to be protected with sterile gauze. Irrigation is used to keep the field clear of debris and provide cooling of the tissue. |
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Term
| What can be used to create an Ostium? |
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Definition
| Punches, a small oscillating saw or a bur. |
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Term
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Definition
| Used to strip the nasal mucosa |
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Term
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Definition
| Needed and used to trim the edges of the opening after the ostium is made. |
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Term
| Where is a vertical cut made? |
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Definition
| in the anterior wall of the lacrimal sac |
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Term
| What way is the wall of the sac slit and which way is the nasal mucosa incised? |
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Definition
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Term
| What is used to join the flaps of the nasal mucose and lacrimal sac? |
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Definition
| 6-0 polyglactin or 9-0 monofilament nylon sutures. |
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Term
| When joining the flaps what should the sutures be done under? |
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Definition
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Term
| What is the use of Gelatin Sponges? |
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Definition
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Term
| What is used to close the skin? |
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Definition
| 7-0 interrupted braided silk |
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Term
| What can be done with a silicone tube by some surgeons? |
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Definition
| Some suture a silicone tube using absorbable sutures to the anterior wall of the sac above and a nylon suture to the nasal septum at the nares. |
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Term
| What can the complications be? |
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Definition
| Permanent facial scar, hemorrhage and post-operative SSI |
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Term
| If used, when is the silicone tube removed? |
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Definition
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