Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, United Kingdom.
Ophthalmic Plast Reconstr Surg. 2011 Jan-Feb;27(1):15-20. doi: 10.1097/IOP.0b013e3181efa695.
The authors report their experience of using a modified bone nibbler as an adjunct to achieving an adequate superior osteotomy for full lacrimal sac exposure during endoscopic dacryocystorhinostomy.
Prospective interventional case series of 19 procedures performed from September 2008 to May 2009. Nasal mucosal flaps were fashioned and osteotomy was started using a Kerrison punch. The modified bone nibbler was then used to complete superior osteotomy to allow full sac exposure beyond its fundus. Lacrimal sac marsupialization and flaps were completed. Primary success was defined as full sac exposure equivalent to that normally achieved using powered instrumentation (PI) in our unit. PI was used if adequate osteotomy had not been achieved. Secondary success was defined as anatomical patency and symptom relief based on fluorescein flow on nasoendoscopy and patency to lacrimal syringing.
Nineteen endoscopic dacryocystorhinostomy procedures in 18 patients were carried out with the nibbler by, or under supervision of, the senior surgeon over an 8-month period. The mean patient age was 52 years (range, 26-78 years). The median follow up was 6 months (4-36 weeks). Septoplasty was required in 4 (21%) cases. In 16/19 (84.2%) cases, full sac exposure was achieved with the nibbler. Three patients required PI to complete the osteotomy. Symptomatic and anatomical success with a patent nasolacrimal system was achieved in all cases (100%).
We report the use of a new modified bone nibbler for removal of superior bone, even as high as the nasal roof, which previously in our practice could be removed only with PI. It allows a large osteotomy comparable to that achieved with powered endoscopic dacryocystorhinostomy yet avoids the disposable costs of PI.
作者报告了他们在使用改良骨咬骨钳辅助内窥镜下泪囊鼻腔吻合术中充分暴露泪囊时，进行上骨切开术的经验。
2008 年 9 月至 2009 年 5 月进行的前瞻性介入性病例系列研究，共 19 例。制作鼻黏膜瓣，使用 Kerrison 骨钻开始行骨切开术。然后使用改良骨咬骨钳完成上骨切开术，以允许充分暴露泪囊超过其底部。完成泪囊袋状造口术和皮瓣。主要成功定义为充分暴露泪囊，相当于我们单位使用动力器械（PI）通常达到的效果。如果未达到足够的骨切开术，则使用 PI。次要成功定义为基于鼻内镜下荧光素流动和泪道冲洗通畅的解剖通畅和症状缓解。
18 名患者中的 19 例进行了内窥镜下泪囊鼻腔吻合术，由资深外科医生或在其监督下使用咬骨钳进行，历时 8 个月。患者平均年龄为 52 岁（范围，26-78 岁）。中位随访时间为 6 个月（4-36 周）。4 例（21%）需要行鼻中隔成形术。16/19 例（84.2%）通过咬骨钳充分暴露泪囊。3 例需要使用 PI 完成骨切开术。所有病例均实现了具有通畅鼻泪管系统的症状和解剖学成功（100%）。
我们报告了一种新型改良骨咬骨钳的使用，用于去除包括鼻顶在内的高位骨，而在我们的实践中，这些骨只能用 PI 去除。它可以进行与动力性内窥镜下泪囊鼻腔吻合术相当的大骨切开术，同时避免了 PI 的一次性成本。
