ORIGINAL ARTICLE
Time taken for superior osteotomy in primary powered endoscopic dacryocystorhinostomy: is there a difference between an ultrasonic aspirator and a mechanical burr? Mohammad Javed Ali, MBBS, MD, FRCS1 , Anasua Ganguly, MD1 , Mohammad Hasnat Ali, MBA2 and Milind N. Naik, MD1
Background: The purpose of this study is to report the time taken for superior osteotomy and complications during this step in primary powered endoscopic dacryocystorhinostomy (PEnDCR) using the piezoelectric system and mechanical burr. Methods: This prospective interventional comparative series was performed on all consecutive patients who underwent a primary PEnDCR over a 4-month period. The surgery was performed as per standard protocols and all patients were operated on by a single surgeon (M.J.A.). Parameters documented were demographic data, type of powered instrument used, time taken for superior osteotomy, exposure of the agger nasi, exposure of entire sac, and complications such as excess bleeding, so tissue injury, or mucosal burns. Statistical analyses were performed using the linear mixed-effect model and 2-sample t tests. Results: A total of 55 PEnDCRs were studied, 29 in the mechanical burr group and 26 in the piezoelectric or ultrasonic group. The mean time for superior osteotomy in the mechanical burr group was 3.71 minutes (range, 1.75 to 6.58 minutes); in the ultrasonic group it was 4.12 minutes (range, 1.33 to 6.25 minutes). There was no significant difference (p = 0.17) between the 2 groups. Subcategory analyses of
P
owered endoscopic dacryocystorhinostomy (PEnDCR) is a well-established surgical modality for treatment
1 Dacryology
Service, L.V. Prasad Eye Institute, Hyderabad, India; for Clinical Epidemiology and Biostatistics, L.V. Prasad Eye Institute, Hyderabad, India
2 Center
Correspondence to: Mohammad Javed Ali, MBBS, MD, FRCS, L.V. Prasad Eye Institute, Road No 2, Banjara Hills, Hyderabad-34, India; e-mail: [email protected] Potential conflict of interest: M.J.A. receives royalties from Springer for his textbook “Principles and Practice of Lacrimal Surgery.” All other authors declare no conflicts of interest. Received: 27 January 2015; Revised: 16 February 2015; Accepted: 17 February 2015 DOI: 10.1002/alr.21522 View this article online at wileyonlinelibrary.com.
time taken by age (p = 0.057) and sex (p = 0.56) did not show any difference between the groups. Two patients in the mechanical burr group had an insignificant superficial sac injury and 1 patient in the ultrasonic group suffered epithelial burns away from the site of osteotomy, which resolved spontaneously without any sequelae. There was no excess bleeding in any of the groups. Conclusion: The time taken by mechanical burr and piezoelectric system are comparable for superior osteotomy in PEnDCR. If anatomical boundaries are respected, their use C 2015 appears to be safe without major complications. ARS-AAOA, LLC.
Key Words: ultrasound; piezosurgery; dacryocystorhinostomy; DCR; time; mechanical; drill How to Cite this Article: Ali MJ, Ganguly A, Ali MH, Naik MN. Time taken for superior osteotomy in primary powered endoscopic dacryocystorhinostomy: is there a difference between an ultrasonic aspirator and a mechanical burr? Int Forum Allergy Rhinol. 2015;5:764–767.
of nasolacrimal duct obstructions, with a high success rate.1–4 The key steps for a successful outcome are creation of an ostium large enough to completely expose the entire length of the lacrimal sac, full-length sac marsupialization, and complete mucosa to mucosa approximation to encourage healing by primary intention.1–4 Superior osteotomy is an important step to achieve full exposure of the sac, and various modalities have been employed to achieve this, including use of chisel and mallet, special bone nibblers, lasers, mechanical burrs, and ultrasonic emulsification.2, 5–8 Mechanical burrs are popular and commonly used for quick removal of the superior bone; however, ultrasonic emulsification is fast emerging as an alternative and safe powered instrument, although there is limited data on the surgical outcomes using
International Forum of Allergy & Rhinology, Vol. 5, No. 8, August 2015
764
Superior osteotomy in endoscopic DCR
FIGURE 1. Complications during superior osteotomy. (A) Photograph showing ultrasonic or piezoelectric hand piece to the left and DCR mechanical burr on the right side. (B) Endoscopic view of the right nasal cavity showing a superficial lacrimal sac injury (black arrow). (C) External photograph showing the vestibular burn. (D) Endoscopic view of the left nasal cavity showing the surface burn of the anteroinferior septal mucosa. DCR = dacryocystorhinostomy.
the ultrasonic instruments.6, 8–10 Few studies in the past have looked at the time taken for a DCR using different approaches and techniques and it has become obvious that the time taken is influenced by the experience of the surgeon and the number of steps involved, which may vary with different approaches.7, 10 The current study evaluates and compares 2 powered instruments: mechanical burrs and ultrasonic emulsification, with regard to the time taken to perform superior osteotomy and complications during this step of PEnDCR.
tions during this step of endoscopic DCR. For comparison according to age, the groups were divided into pediatric and adult,
Time taken for superior osteotomy in primary powered endoscopic dacryocystorhinostomy: is there a difference between an ultrasonic aspirator and a mechanical burr? Mohammad Javed Ali, MBBS, MD, FRCS1 , Anasua Ganguly, MD1 , Mohammad Hasnat Ali, MBA2 and Milind N. Naik, MD1
Background: The purpose of this study is to report the time taken for superior osteotomy and complications during this step in primary powered endoscopic dacryocystorhinostomy (PEnDCR) using the piezoelectric system and mechanical burr. Methods: This prospective interventional comparative series was performed on all consecutive patients who underwent a primary PEnDCR over a 4-month period. The surgery was performed as per standard protocols and all patients were operated on by a single surgeon (M.J.A.). Parameters documented were demographic data, type of powered instrument used, time taken for superior osteotomy, exposure of the agger nasi, exposure of entire sac, and complications such as excess bleeding, so tissue injury, or mucosal burns. Statistical analyses were performed using the linear mixed-effect model and 2-sample t tests. Results: A total of 55 PEnDCRs were studied, 29 in the mechanical burr group and 26 in the piezoelectric or ultrasonic group. The mean time for superior osteotomy in the mechanical burr group was 3.71 minutes (range, 1.75 to 6.58 minutes); in the ultrasonic group it was 4.12 minutes (range, 1.33 to 6.25 minutes). There was no significant difference (p = 0.17) between the 2 groups. Subcategory analyses of
P
owered endoscopic dacryocystorhinostomy (PEnDCR) is a well-established surgical modality for treatment
1 Dacryology
Service, L.V. Prasad Eye Institute, Hyderabad, India; for Clinical Epidemiology and Biostatistics, L.V. Prasad Eye Institute, Hyderabad, India
2 Center
Correspondence to: Mohammad Javed Ali, MBBS, MD, FRCS, L.V. Prasad Eye Institute, Road No 2, Banjara Hills, Hyderabad-34, India; e-mail: [email protected] Potential conflict of interest: M.J.A. receives royalties from Springer for his textbook “Principles and Practice of Lacrimal Surgery.” All other authors declare no conflicts of interest. Received: 27 January 2015; Revised: 16 February 2015; Accepted: 17 February 2015 DOI: 10.1002/alr.21522 View this article online at wileyonlinelibrary.com.
time taken by age (p = 0.057) and sex (p = 0.56) did not show any difference between the groups. Two patients in the mechanical burr group had an insignificant superficial sac injury and 1 patient in the ultrasonic group suffered epithelial burns away from the site of osteotomy, which resolved spontaneously without any sequelae. There was no excess bleeding in any of the groups. Conclusion: The time taken by mechanical burr and piezoelectric system are comparable for superior osteotomy in PEnDCR. If anatomical boundaries are respected, their use C 2015 appears to be safe without major complications. ARS-AAOA, LLC.
Key Words: ultrasound; piezosurgery; dacryocystorhinostomy; DCR; time; mechanical; drill How to Cite this Article: Ali MJ, Ganguly A, Ali MH, Naik MN. Time taken for superior osteotomy in primary powered endoscopic dacryocystorhinostomy: is there a difference between an ultrasonic aspirator and a mechanical burr? Int Forum Allergy Rhinol. 2015;5:764–767.
of nasolacrimal duct obstructions, with a high success rate.1–4 The key steps for a successful outcome are creation of an ostium large enough to completely expose the entire length of the lacrimal sac, full-length sac marsupialization, and complete mucosa to mucosa approximation to encourage healing by primary intention.1–4 Superior osteotomy is an important step to achieve full exposure of the sac, and various modalities have been employed to achieve this, including use of chisel and mallet, special bone nibblers, lasers, mechanical burrs, and ultrasonic emulsification.2, 5–8 Mechanical burrs are popular and commonly used for quick removal of the superior bone; however, ultrasonic emulsification is fast emerging as an alternative and safe powered instrument, although there is limited data on the surgical outcomes using
International Forum of Allergy & Rhinology, Vol. 5, No. 8, August 2015
764
Superior osteotomy in endoscopic DCR
FIGURE 1. Complications during superior osteotomy. (A) Photograph showing ultrasonic or piezoelectric hand piece to the left and DCR mechanical burr on the right side. (B) Endoscopic view of the right nasal cavity showing a superficial lacrimal sac injury (black arrow). (C) External photograph showing the vestibular burn. (D) Endoscopic view of the left nasal cavity showing the surface burn of the anteroinferior septal mucosa. DCR = dacryocystorhinostomy.
the ultrasonic instruments.6, 8–10 Few studies in the past have looked at the time taken for a DCR using different approaches and techniques and it has become obvious that the time taken is influenced by the experience of the surgeon and the number of steps involved, which may vary with different approaches.7, 10 The current study evaluates and compares 2 powered instruments: mechanical burrs and ultrasonic emulsification, with regard to the time taken to perform superior osteotomy and complications during this step of PEnDCR.
tions during this step of endoscopic DCR. For comparison according to age, the groups were divided into pediatric and adult,
