Although several studies have commented on the causes of DCR failure, a detailed description of anatomical findings in such cases remains insufficient.

The researchers conducted this study to analyze radiologic, endoscopic, and intraoperative findings in patients presenting with failed DCR and secondarily assess the outcome of revision endo-DCR carried out at our institution.

Twenty-four failed DCRs presenting to our tertiary care center were retrospectively analyzed. Data collection included patients’ history, diagnostic, and management data and thorough analysis of sinonasal CT scans, along with endoscopic and intraoperative findings. The outcome was also assessed in 21 cases with revision endo-DCR performed.

The lacrimal bone was detected covering the posterior sac despite removing the anterior ascending process of the maxilla on nine sides. Rhinostoma was anterior to the lacrimal sac on two sides and was below the sac on seven sides. Fibrous membrane covered the rhinostoma despite the removal of all sac-overlying bones on six sides. Nineteen of the 21 revision endo-DCRs were successful.

The study concluded that a precise anatomical description of findings in cases of failed DCR. Such information is paramount in helping surgeons enhance their learning curve, refine the surgical technique, and improve patients’ outcomes.

Reference: https://journals.sagepub.com/doi/full/10.1177/1945892418815044