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Fundamentals of Clinical Ophthalmology (part 10)

Một thang máy tự do được đặt gần các sườn núi lệ đạo, chuẩn bị để nâng cao nắp niêm mạc (có thể nhìn thấy máu là gây tê tại chỗ); 16.4b nắp mucoperiosteal được nâng lên với một thang máy tự do hơn (F). 16.5a kẹp Blakesley được sử dụng để nắm bắt và tiêu thụ đặc biệt niêm mạc mũi, 16.5b các xương lệ đạo được lấy ra với Blakeseley kẹp | PLASTIC and ORBITAL SURGERY 16.7a Figure 16.3 a-16.7b Right endonasal surgical DCR 16.3a The light beam is visible in the middle meatus on the lateral nasal wall 16.3b view of light-pipe transillumination with 30 Hopkins endoscope S septum LR lacrimal ridge MT middle turbinate E endoscope. 16.4a A freer elevator is placed close to the lacrimal ridge in preparation for raising the mucosal flap visible blood is from local anaesthesia 16.4b the mucoperiosteal flap is raised with a freer elevator F . 16.5a Blakesley forceps are used to grasp and excise nasal mucosa 16.5b the lacrimal bone is removed with Blakeseley forceps B . 16.6a The lacrimal sac mucosa is opened with an angled keratome 16.6b an angled keratome K is used to open the lacrimal sac. 16.7a Silicon intubation is passed and knotted in the nasal space 16.7b the intubation is retrieved from the nose using curved artery forceps ST Silicone tube B bodkin. Figure 16.8 Holmium-YAG laser is being used to ablate nasal mucosa just anterior to the area of transillumination during left endonasal laser DCR. in the post operative period. The silicone intubation is typically removed after 6-12 weeks and the function of the anastomosis assessed at about six months. 172 Complications specific to endonasal surgery may include canalicular damage as a result of the greater instrumentation collateral laser damage to the mucosa of the nose or lacrimal sac or the formation of granulation tissue at the rhinostomy or scarring during the healing phase. If the rhinostomy fails due to fibrosis the anastomosis may be revised either with further endonasal surgery or by external DCR Chapter 15 . Various success rates have been reported Tables 16.1 and 16.2 but the perioperative use of a topical anti-metabolite such as Mitomycin C appears to reduce the failure rate by decreasing the fibrosis associated with secondary intention healing. Further reading Boush GA Lempke BN Dortzbach RK. Results of endonasal laser-assisted .