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Dacriocistorrinostomia endoscópica
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Foi há mais de 2000 anos que se criou o primeiro procedimento que permitiu uma passagem artificial, através da punção do osso lacrimal, entre o saco lacrimal e o nariz. Desde então esse procedimento sofreu muitas alterações e evoluiu acompanhando os avanços na medicina e na tecnologia. A DCR endoscópica teve um grande desenvolvimento nos últimos anos devido ao desenvolvimento de endoscópios nasais e aos avanços no conhecimento anatómico. Com uma boa avaliação pré-operatória por oftalmologistas e otorrinolaringologistas e com o auxílio de meios complementares de diagnóstico, tais como o teste de irrigação, a dacriocistografia, a tomografia computorizada e endoscopia nasal consegue-se chegar a um diagnóstico e à decisão se a DCR é o procedimento indicado no caso em questão. A DCR é indicada nos casos de obstrução total ou quase total da via lacrimal. A DCR endoscópica visa reestabelecer a comunicação entre a via lacrimal e as fossas nasais e isto faz-se através da criação de uma passagem artificial com a mucosa do saco lacrimal e da mucosa nasal. As complicações são raras e as taxas de recidiva pequenas quando o procedimento é realizado por um cirurgião experiente. Em comparação com a DCR externa, a DCR endoscópica tem vindo a ser cada vez mais utilizada, principalmente devido ao facto de esta última não necessitar de uma incisão na pele e sua consequente cicatrização e por ter um recobro mais rápido. A DCR endoscópica apresenta actualmente taxas de sucesso semelhantes à DCR externa, sendo portanto um procedimento com perspectivas futuras promissoras.
It was more than 2000 years ago that the first procedure which allowed an artificial passage between the lacrimal sac and the nose, by puncturing the tear bone was created. Since then this procedure has undergone many changes and evolved following the advances in medicine and technology. Endoscopic DCR has developed greatly in recent years due to the development of nasal endoscopes and advances in anatomical knowledge. With a good preoperative evaluation by ophthalmologists and otorhinolaryngologists and also with the aid of complementary diagnostic means, such as the irrigation test, dacryocystography, computed tomography and nasal endoscopy, a diagnosis can be reached and the decision can be made if the DCR is the procedure indicated in the case in question. DCR is indicated in cases of total or almost total obstruction of the lacrimal pathway. The endoscopic DCR aims to reestablish the communication between the lacrimal pathway and the nasal cavities and this is done through the creation of an artificial passageway with the mucosa of the lacrimal sac and the nasal mucosa. Complications are rare and relapse rates are small when the procedure is performed by an experienced surgeon. Compared with external DCR, endoscopic DCR has been increasingly used, mainly due to the fact that the latter does not require an incision in the skin and its consequent scarring and to have a faster recovery. Endoscopic DCR currently has success rates similar to external DCR, and is therefore a procedure with promising future prospects.
It was more than 2000 years ago that the first procedure which allowed an artificial passage between the lacrimal sac and the nose, by puncturing the tear bone was created. Since then this procedure has undergone many changes and evolved following the advances in medicine and technology. Endoscopic DCR has developed greatly in recent years due to the development of nasal endoscopes and advances in anatomical knowledge. With a good preoperative evaluation by ophthalmologists and otorhinolaryngologists and also with the aid of complementary diagnostic means, such as the irrigation test, dacryocystography, computed tomography and nasal endoscopy, a diagnosis can be reached and the decision can be made if the DCR is the procedure indicated in the case in question. DCR is indicated in cases of total or almost total obstruction of the lacrimal pathway. The endoscopic DCR aims to reestablish the communication between the lacrimal pathway and the nasal cavities and this is done through the creation of an artificial passageway with the mucosa of the lacrimal sac and the nasal mucosa. Complications are rare and relapse rates are small when the procedure is performed by an experienced surgeon. Compared with external DCR, endoscopic DCR has been increasingly used, mainly due to the fact that the latter does not require an incision in the skin and its consequent scarring and to have a faster recovery. Endoscopic DCR currently has success rates similar to external DCR, and is therefore a procedure with promising future prospects.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Palavras-chave
Dacriocistorrinostomia Obstrução da via lacrimal Teste de irrigação Endoscópio nasal Otorrinolaringologia