Complications of standardized endonasal dacryocystorhinostomy with unciformectomy.

Purpose: To report the nature and frequency of complications occurring with endonasal dacryocystorhinostomy (DCR) based on routine unciformectomy.

Design: Prospective, noncomparative interventional consecutive case series study.

Participants: Endonasal DCR was performed on 300 patients with complete nasolacrimal stenosis.

Methods: The uncinate process was resected (unciformian endonasal DCR), except when the lacrimal fossa was anterior to its insertion (23 cases [7.7%]). Preoperative clinical assessment and computed tomography scans, intraoperative endoscopic video recording, and postoperative clinical and endoscopic follow-ups were analyzed for reported endonasal DCR failure and complications. The mean follow-up was 13+/-12.6 months (range, 1-57).

Main Outcome Measures: Failure rate, nature, frequency, and time of intraoperative and postoperative complications.

Results: Of the 300 patients treated, 39 (13%) suffered from residual epiphora and no passage upon irrigation; there was secondary canalicular stenosis in 2 cases (0.6%), sump syndrome in 4 cases (1.2%), a distal stenosis from progressive healing closure of the ostium in 21 cases (7.0%), a recurrence of lacrimal mucocele in 5 cases (1.7%), and adhesions between the ostium and septum in 2 cases (0.6%). Access to the surgical site required an anterior middle turbinectomy in 103 cases (34.3%) and a septoplasty in 1 case (0.3%). Intraoperative bleeding was minor in 183 (60.6%), moderate in 82 (27.3%), and severe in 35 cases (11.6%). Postoperative bleeding occurred in 4 cases, and was controlled by packing. Transient frontal sinusitis (n = 1), nasal mucosa burn (n = 1), cacosmia (n = 8), phlebitis (n = 1), and maxillary pain (n = 8) also occurred. Orbital fat prolapse, cerebrospinal fluid leaking, cutaneous scarring, diplopia, and loss of vision did not occur.

Conclusion: Complications from unciformian endonasal DCR may be less frequent or severe than with maxillary endonasal DCR, and comparable to or less frequent than those for external DCR.