Abstract Listings 2024

Purpose

The thickness and angulation of the frontal process of the maxilla is a limiting factor in efficient osteotomy formation in endoscopic dacryocystorhinostomy (endo-DCR), often necessitating the use of powered instrumentation. Right- and left-curved rongeurs designed for spinal foraminotomy might enhance surgical access and improve ostium formation.

Methods

Endo-DCRs were performed by Ophthalmic surgeons on 24 sides of 12 fresh frozen cadavers in an anatomy laboratory. Surgeons were instructed to use standard straight rongeurs only. Once the biggest possible ostium had been created with standard rongeurs, surgeons switched to curved foraminotomy rongeurs to further enlarge the ostium. Finally, powered tools were employed to remove any remaining bone if necessary. At each change of instrument, all removed bone was collected and weighed, and an experienced surgeon evaluated the percentage of lacrimal sac exposure. Wilcoxon signed-rank test determined if the curved rongeurs facilitated any significant difference in bone removal or sac exposure.

Results

From the 24 DCRs performed, straight rongeurs removed a median (and interquartile range) of 229.5mg (195.2-276.5) of bone, with 60% (50-63.3) of the lacrimal sac exposed. With the addition of curved rongeurs during the same DCR, a median of 449.5mg (380.5-589.2, p<0.0001) was removed and 90% (78.8-100, p<0.0001) of the lacrimal sac was exposed.

Conclusion

There is a significant improvement in the amount of bone that can be removed with the addition of curved foraminotomy rongeurs during endo-DCR with greater exposure of the lacrimal sac. While two-thirds of cases still required some (albeit less) powered instrumentation to fully expose the sac, this demonstrates a promising advance in surgical instrumentation for endo-DCR.

Additional Authors

↑ Back to top