Department of Ophthalmology, University of California, Irvine, California 92697, USA.
Ophthalmic Plast Reconstr Surg. 2010 Jan-Feb;26(1):39-41. doi: 10.1097/IOP.0b013e3181b8c718.
Dacryocystorhinostomy (DCR) success may depend on mucous membrane alignment across the osteotomy and entire surgical lacrimal outflow conduit. Scar tissue, obliteration of the lacrimal sac, and obstruction at the level of the common canaliculus may result from prior surgery or may occur as an isolated problem. We describe and evaluate the efficacy of a technique of grafting autologous buccal mucous membrane during external DCR in cases complicated by scarring and/or common canalicular obstruction.
We retrospectively reviewed 11 nasolacrimal outflow system obstructions (in 9 patients) treated with a buccal mucous membrane graft-assisted DCR. The surgical technique is described in detail.
All cases presented with insufficient nasolacrimal outflow. Ten tear ducts failed prior DCR procedures, while one case had isolated common canalicular obstruction, resistant to multiple probing and intubation and was previously recommended a Jones tube procedure. Three tear outflow systems (in 2 patients) exhibited common canalicular obstruction; the rest were obstructed at the level of the lacrimal sac. Two patients had bilateral obstruction. Ten eyes had symptomatic epiphora. One eye had dacryocystitis alone, and 2 eyes had dacryocystitis and epiphora. Six tear ducts had more than one previous DCR procedure. Four tear ducts had prior endonasal DCR procedures, while 6 had a previous external DCR. All eyes with epiphora preoperatively had complete relief of tearing. All cases of dacryocystitis resolved with no recurrences. Nine tear ducts were patent to irrigation testing postoperatively (2 were not tested).
Buccal mucous membrane grafting may improve the success of DCR in cases complicated by scarring, mucosal shortage, and/or common canalicular obstruction.
鼻内泪囊吻合术（DCR）的成功可能取决于吻合口和整个泪道外科引流系统的粘膜对齐。疤痕组织、泪囊闭塞和泪小管水平的阻塞可能是先前手术的结果，也可能是孤立的问题。我们描述并评估了在伴有瘢痕和/或共同管阻塞的情况下，在外部 DCR 中移植自体颊粘膜技术的疗效。
我们回顾性分析了 11 例（9 例患者）鼻泪管阻塞患者，这些患者均接受了颊粘膜移植辅助 DCR 治疗。详细描述了手术技术。
所有病例均表现为鼻泪管流出不足。10 例泪道在先前的 DCR 手术中失败，1 例孤立的共同管阻塞，对多次探针和插管均有抵抗作用，先前建议行 Jones 管手术。3 例泪液流出系统（2 例患者）存在共同管阻塞；其余在泪囊水平阻塞。2 例患者双侧阻塞。10 只眼有症状性溢泪。1 只眼单纯性泪囊炎，2 只眼合并泪囊炎和溢泪。6 只泪道有不止一次的先前 DCR 手术。4 只泪道有先前的经鼻 DCR 手术，6 只泪道有先前的外部 DCR。所有术前溢泪的眼睛均完全缓解流泪。所有的泪囊炎病例均得到治愈且无复发。9 只泪道在术后的冲洗测试中是通畅的（2 只未进行测试）。
在伴有瘢痕、粘膜短缺和/或共同管阻塞的情况下，颊粘膜移植可能会提高 DCR 的成功率。
