Outcomes of revision external dacryocystorhinostomy and nasal intubation by bicanalicular silicone tubing under endonasal endoscopic guidance

AIM: To evaluate the long-term treatment outcomes in patients who underwent revision of external dacryocysto- rhinostomy (DCR) and nasal intubation by bicanalicular silicone tubing (BSTI) under endonasal endoscopic guidance. · METHODS: Data from 28 patients with recurrent dacryocystitis were retrospectively reviewed. Revision external DCR and bicanalicular nasal intubation by silicone tubing under endonasal endoscopic guidance was performed in 28 eyes of 28 patients. The patients were evaluated with respect to the reason of recurrence, time to recurrence, time to revision, duration of follow-up and surgical success. · RESULTS: Endoscopic endonasal examination detected an osteotomy-side obstruction by the excessive granulation tissue in 24 patients (86%), nasal septal deviation in three patients (10%) and nasal polyp in one patient (4%). Recurrence occurred after a mean duration of 5.3±3.7 months following the first operation. The mean time between the first DCR operation and the revision DCR was 11.5 ± 9.3 months. After a mean follow-up of 14.9±7.8 months, the rate of anatomic success alone was 85% (24/28); the rate of subjective success was 78% (22/28). · CONCLUSION: Revision external DCR and bicanalicular nasal intubation by silicone tubing under endonasal endoscopic guidance can be recommended in patients with recurrent dacryocystitis as a surgical approach that achieves satisfactory objective and subjective success rates.

Endoscopic dacryocystorhinostomy with bicanalicular silicone tube intubation for treating chronic dacryocystitis secondary to nasolacrimal duct stent incarceration

AIM:To investigate the feasibility of endoscopic dacryocystorhinostomy(En-DCR)with bicanalicular silicone tube intubation for treating chronic dacryocystitis secondary to nasolacrimal duct stent(NDS)incarceration.METHODS:En-DCRs were performed on 44 chronic dacryocystitis patients(46 eyes)secondary to NDS incarceration from April 2016 to October 2022.The granuloma and scar tissues were separated,and the removal of NDS incarceration was achieved during the surgery;the flap of the lacrimal sac was trimmed and anastomosed with nasal mucosal,a bicanalicular silicone tube was implanted,and lacrimal size and condition were assessed.The tube was removed 3mo after surgery.During the final follow-up of 12mo when the surgery was completed,the complications and the rates of surgical success were assessed.RESULTS:This study covered 40 patients(42 eyes).Intraoperatively,it was found that the lacrimal sac became small,and the sac wall had granulation and scar tissue attached to the incarcerated NDS in all eyes.At 12mo after surgery completed,the rates of the functional and anatomical success reached 80.95%(34/42)and 83.33%(35/42),respectively.Under the effect of intranasal ostial closure,seven eyes failed to achieve anatomical success.No serious complications(e.g.,visual impairment,sinusitis,and orbital fat prolapse)was observed.CONCLUSION:With the success rate over 80%and no serious complications,En-DCR with bicanalicular silicone tube implantation is effective in treating chronic dacryocystitis secondary to NDS incarceration.

Surgical outcomes in acute dacryocystitis patients undergoing endonasal endoscopic dacryocystorhinostomy with or without silicone tube intubation

AIM:To establish the necessity of silicone tube intubation in acute dacryocystitis(AD)patients undergoing endonasal endoscopic dacryocystorhinostomy(En-DCR).METHODS:Patients presenting with unilateral AD were randomly assigned to two treatment groups.En-DCR procedures were performed following lacrimal abscess formation,with the operation being performed with silicone intubation for patients in group B but not group A.Functional success was defined by an absence of additional AD episodes,no epiphora,and ostium patency as established via endoscopic evaluation or fluorescein irrigation.Operative success rates and demographic variables were compared between treatment groups.RESULTS:In total,66 patients were analyzed in the present study(33 per group),with complete postoperative data having been successfully collected from 27 and 22 patients in group A and group B,respectively.All patients exhibited complete resolution of acute inflammation.Upon follow-up,granulation tissue was detected around the ostium at higher rates in group B(9/22,40.9%)relative to group A(4/27,14.8%).At the 12-month follow-up time point,patients in group A exhibited higher success rates(25/27,92.6%)relative to patients in group B(20/22,90.9%),but this difference was not significant.Cases of lacrimal passage reconstruction failure in both groups were attributed to excessive fibrous and/or granulation tissue formation proximal to the intranasal ostium.CONCLUSION:Given that these two operative approaches are associated with similar rates of operative success and in light of differences in granulation tissue formation,cost,and operative duration,these data do not support the routine silicone intubation of AD patients following En-DCR surgery.

Fascial pedicle artificial nerve tissue compared with silicone tube bridging to repair sciatic nerve defects in rats

BACKGROUND： Silicone tube bridging for peripheral nerve defects has been shown to be successful in guiding neural regeneration. However, this method is accompanied by complications. Because materials for bridging nerve fibers should exhibit biocompatibility, the development of novel artificial tissues to bridge nerve grafts has become important in the field of nerve tissue engineering for the repair of peripheral nerve defects. OBJECTIVE： To investigate effectiveness and feasibility of fascial pedicle artificial nerve tissue to repair peripheral nerve defects, and to compare to autologous nerve grafts and silicone tube bridging methods. DESIGN, TIME AND SETTING： Randomized, controlled, neural tissue engineering-based, animal experiments were performed at the Laboratory of Human Anatomy in Qingdao University Medical College from March 2006 to March 2007. MATERIALS： Medical absorbable collagen sponge was purchased from Henan Province Tiangong BJo-Material, China. Cantata 2-track 4-trace EMG-evoked potential instrument was purchased from Dantec, Denmark. Medical silicone tube was purchased from Shenzhen Legend Technology, China. METHODS： Forty healthy, adult, male, Sprague Dawley rats were randomly assigned to four groups fascial pedicle nerve, autologous nerve, silicone tube, and normal, with 10 rats in each group. A 10-mm defective sciatic nerve section was produced in rats following the removal of the fascial pedicle. The fascial flap surrounding the defect was harvested; one side of the nerve pedicle was maintained and then sutured into a tube with the fascia surface as the pipe inner wail. The tube was filled with a medical absorbable collagen （Bodyin） to construct a bridge between the artificial tissue nerve graft and the damaged sciatic nerve. The sciatic nerve defects in the autologous nerve and silicone tube groups were bridged using autologous nerve grafts and a medical silicone tube with matched specifications. MAIN OUTCOME MEASURES： At 4 months after transplantation, electromyogram was used to detect sciatic nerve conduction velocity and action potential amplitude. Hematoxylin-eosin and Nissl staining were used to determine the number of spinal cord anterior horn motor neurons and neurites Osmium tetroxide staining of the sciatic nerve bridge section was performed to detect the number and diameter of nerve fibers. RESULTS： There were no differences in sciatic nerve conduction velocity, action potential amplitude, the number of spinal cord anterior horn motor neurons and neurites, sciatic nerve fiber number, and diameter between the autologous nerve graft and normal groups （P 〉 0.05）. However, these values were significantly greater than in the silicone tube group （P 〈 0.05）. CONCLUSION： Quantitative results suggested that artificial nerve tissue, with an autologous tissue fascia flap as a nerve conduit, could be used to repair peripheral nerve defects. The regenerated fascial pedicle artificial nerve tissue was similar to an autologous nerve graft in terms of morphology and functional recovery and was superior to results from silicone tube bridging transplants.

Effect of intubation in patients with functional epiphora after endoscopic dacryocystorhinostomy

AIM:To investigate the effect of bicanalicular silicone tube intubation(BSTI)in the treatment of functional epiphora after endoscopic dacryocystorhinostomy(En-DCR).METHODS:Clinical data of 84 patients(95 eyes)with functional epiphora after En-DCR were retrospectively analyzed.Functional epiphora was confirmed as persistent or recurrent epiphora by fluorescein dye disappearance test(FDDT),lacrimal irrigation test,as well as endoscopic examination.Secondary BSTIs were recommended for patients with functional epiphora.These tubes were removed 1mo after surgery.Functional success and associated complications were assessed after 2y of follow-up.RESULTS:Seven patients(9 eyes)refused intervention,5 patients(6 eyes)did not complete postoperative followup,and 1 patient(1 eye)developed tube prolapse within 1mo after surgery.Seventy-one patients(79 eyes)were included at last.Functional success ratios at six months,one year,as well as two years post-operation were 94.9%(75/79),92.4%(73/79),and 91.1%(72/79),respectively.Three eyes presented with punctal slitting(2 eyes without epiphora),1 eye with proximal canaliculus slitting,1 eye with canaliculus stenosis and 4 eyes with still present functional epiphora without detectable abnormal at the last follow-up.CONCLUSION:Secondary intubation is an effective procedure with low recurrence probability for functional epiphora after En-DCR.Punctal and canaliculus injury are the main tube-associated complications after secondary intubation.

Effects of estradiol-17β and bisphenol A administered chronically to mice throughout pregnancy and lactation on the male pups＇ reproductive system

Aim： To assess the effect of estradiol-17β （E2） and bisphenol A （BPA） administered chronically by implanting a silicone tube throughout pregnancy and lactation on male pups＇ reproductive system in ICR mice. Methods： Female mice were implanted with a tube filled with 10 ng, 500 ng, 1 μg, or 10 μg of E2, or 100 μg or 5 mg of BPA, before mating. The tube was kept in the mice throughout pregnancy and lactation, until the pups had weaned at 4 weeks of age. During the period, E2 was released from the tube at 120 pg or 6, 12 or 120 ng/day, and BPA at 1.2 or 60 μg/day. Results： Most of the mice given 1 μg and 10 lag of E2 did not maintain their pregnancy. However, the other groups showed high rates of birth, more than 70%. At age of 4 weeks, the male pups were killed. Body weight and reproductive organ weights （testes, epididymides and accessory reproductive glands） in the treated groups did not differ from the control values, whereas the percentage of seminiferous tubules in the testis with mature spermatids was significantly lower in the groups given 10 ng and 500 ng of E2 and 5 mg of BPA than that in the control. Conclusion： Chronic exposure to E2 and BPA might disrupt spermatogenesis in male pups. （Asian JAndrol 2008 Mar; 10： 271-276）