Comparative evaluation of posterior flap management techniques in external dacryocystorhinostomy: clinical and endoscopic study

Purpose To evaluate endonasal endoscopic postoperative findings and their correlation with the clinical outcomes of external DCR using two different posterior flap management techniques: one with anterior flap anastomosis only and the other with both anterior and posterior flap anastomosis. Methods One hundred candidates for DCR were included in a prospective interventional study. Patients were divided into two groups: (group A) with anastomosis of both anterior and posterior flaps and group B with only anterior flap anastomosis. Nasal endoscopic evaluation was done at 2, 4, and 6 months postoperatively. Results A statistically significant difference in the shape of the ostium was detected between both groups being more regular with a smooth outline in group A. Adherent crusts were found in 38 patients (76.0%), adhesions in 2 cases (4.0%), granuloma in 1 case (2.0%), and positive jones dye-3 test in 47 cases (94.0%) in group A. In group B, adherent crust was in 43 patients (86.0%), adhesions in 6 cases (12.0%), granuloma in 5 cases (10.0%), and positive jones dye-3 test in 44 cases (88.0%). A significant positive association was detected between postoperative recurrent epiphora and the presence of adhesions or granuloma. Symptoms improved by endoscopic intervention. Conclusion Anastomosis of both flaps in DCR will reduce the formation of fibrous adhesions and the development of granuloma thus improving the success rate. Postoperative endonasal endoscopic evaluation is valuable for morphological evaluation and also an interventional technique to increase the success rate.