31239 Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy

Name of the Procedure:

Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy (DCR)

Summary

Nasal/sinus endoscopy with dacryocystorhinostomy is a surgical procedure that involves using an endoscope to access and open a tear duct blockage via the nasal passage. The goal is to create a new tear drainage pathway to relieve symptoms of tear duct obstruction.

Purpose

This procedure addresses blockages in the tear duct system, which can cause excessive tearing or recurrent eye infections. The goal is to restore proper tear drainage and alleviate symptoms.

Indications

• Chronic tearing (epiphora)
• Recurrent eye infections or inflammation (dacryocystitis)
• Congenital tear duct obstruction not resolved by less invasive methods
• Pain or discomfort due to tear duct blockage

Preparation

• Patients may be instructed to fast for a certain period before the procedure.
• Avoidance of certain medications, such as blood thinners, as advised by the doctor.
• Pre-operative assessments, including imaging studies like a dacryocystogram or CT scan, may be required.

Procedure Description

1. The patient is placed under local or general anesthesia.
2. An endoscope, a thin tube with a camera and light, is inserted through the nasal passage to visualize the tear duct area.
3. Surgical instruments are used to create a new opening between the tear sac and the nasal cavity.
4. In some cases, a small tube (stent) may be placed temporarily to keep the new passage open during the healing process.
5. The endoscope and instruments are removed, and the patient is monitored as they wake up from anesthesia.

Duration

The procedure typically lasts between 1 to 2 hours.

Setting

The procedure is usually performed in a hospital or an outpatient surgical center.

Personnel

• ENT (Ear, Nose, and Throat) surgeon or an ophthalmologist with specialized training
• Anesthesiologist
• Surgical nurses

Risks and Complications

• Infection
• Bleeding
• Scarring or granulation tissue formation
• Displacement or blockage of the stent (if used)
• Failure of the new drainage pathway to remain open, necessitating further surgery

Benefits

• Relief from chronic tearing
• Reduction in recurrent eye infections
• Improvement in quality of life with less eye discomfort

Recovery

• Patients may experience nasal congestion or mild discomfort post-procedure.
• Avoid strenuous activities and nasal blowing for a few weeks.
• Use of prescribed nasal sprays or antibiotics as directed to prevent infection.
• Follow-up appointments to monitor the surgical site and remove the stent if used.

Alternatives

• Non-surgical treatments like balloon dacryoplasty or intubation.
• External dacryocystorhinostomy (traditional surgical approach through an incision near the nose).
• Each alternative has varying success rates and recovery times; consultation with a specialist is necessary to determine the best option.

Patient Experience

• During the procedure, patients are under anesthesia and do not feel pain.
• Post-procedure, some nasal congestion, mild discomfort, or drainage might occur.
• Pain is managed with over-the-counter pain relievers or prescribed medications.
• Most patients can resume normal activities within a week, with full recovery in a few weeks.