DACRYOCYSTORHINOSTOMY

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DACRYOCYSTORHINOSTOMY (dacryocystorhinostomia; Greek dakryon a tear + kystis a bubble, a bag + + rhis, rhin [os] hoc + stoma of companies, an opening, pass) — the operation of imposing of an anastomosis between a dacryocyst and a nasal cavity intended for recovery of outflow of a tear in a nasal cavity.

Fig. 1 — 4. The scheme of a dacryocystorhinostomy (according to Dupuis-Dutana): fig. 1 — the shift of a dacryocyst (it is specified by an arrow), an otsloyenny periosteum it is fixed by dilators (at the left above — the line of a skin section)
Fig. 1 — 4. The scheme of a dacryocystorhinostomy (according to Dupuis-Dutana): fig. 2 — formation of a bone opening a mill, borders of a trepanation opening are specified by a dotted line
Fig. 1 — 4. The scheme of a dacryocystorhinostomy (according to Dupuis-Dutana): fig. 3 — a section of a wall of a dacryocyst (1) and a mucous membrane of a nose (2) for imposing of an anastomosis
Fig. 1 — 4. The scheme of a dacryocystorhinostomy (according to Dupuis-Dutana): fig. 4 — suture on back lips of wound openings of a dacryocyst and a mucous membrane of a nose

Indication for D. the acute dacryocystitis in a stage of a zatikhaniye is hron, and (see. Dacryocystitis ), fistula, ectasia of a dacryocyst, and also obliteration of a nasal duct. Almost completely forced out the extirpation of a dacryocyst applied earlier at dacryocystites, before a cut it has big advantages since recovers function of a slezootvedeniye. Operation is offered in 1904 to A. Toti.

Totti's operation consists in a gouging of a bone opening at edge of a dacryocyst with the subsequent removal of a part of a bag and the site of a mucous membrane of a nose. A lack of operation is that at a part of patients granulyatsionny process leads to closing of an opening. For the purpose of the prevention of a recurrence numerous modifications are offered.

Dupuis-Dutana's operation. Instead of the excision of a part of a dacryocyst and a mucous membrane of a nose offered Totti at this operation in them make cuts with the subsequent suture.

Technology of operations. Under infiltration and conduction anesthesia (see. Anesthesia local ) make the arc-shaped section of soft tissues. Begin a section on 3 — k. the mm is higher than the place of an attachment of a medial palpebral commissure and conduct towards a ridge of the nose. Length of coal mine 2 — 3 cm. After disclosure of a wound dilators otslaivat a periosteum, cross an internal sheaf a century at the place of its attachment, remove an internal wall of a dacryocyst from a bone (fig. 1). The special tool (a mill, trepan, the electric drill, boron compasses, etc.) in a bone form an opening (fig. 2) 2 x 1,5 cm in size. The edge of a bone opening even nippers, nippers or a chisel. The mucous membrane of a nose is cut over the fluted probe entered into a nose. In a dacryocyst carry out a vertical cut. Back lips of wound openings of a bag and a mucous membrane of a nose are sewed three catgut or bioseams by means of a needle of Ohm (fig. 3 and 4). On front lips also put three stitches. Seams on skin.

Uest's operation. Consists in excision of a rhomboid mucous graft of a nose according to a projection of a dacryocyst, in formation of a bone window of 1,5 X 1 cm in size and resection of a medial wall of a dacryocyst. Feature of this operation is endonasal approach to a dacryocyst.

Kanalikulorinostomiya it is shown at sharply deformed or absent dacryocyst that takes place at traumatic dacryocystites. Operation consists in creation of an anastomosis between tubules and a mucous membrane of a nose by introduction to the lacrimal tubules and a nasal cavity of threads or plastic tubules.

Fig. 5. Scheme of a konjyunktivodakriotsistorinostomiya: the top of a dacryocyst (it is specified by an arrow) is removed through a wound and the tweezers scissors are cut (at the left below — the line of a skin section). In new situation the dacryocyst is fixed to a conjunctiva, after formation of an anastomosis between a dacryocyst and a nasal cavity the skin wound is closed.
Fig. 6. Scheme of a lakorinostomiya: through the bone opening made by a mill, and the course connecting it to a conjunctival sac the plastic cannula prosthesis (is specified by shooters) connecting the lacrimal lake to a nasal cavity is entered. Top end of a cannula is fixed by silk threads to a medial palpebral commissure, lower — is carried out through a nostril and fixed by an adhesive plaster to a cheek (at the left below).

Konjyunktivodakriotsistorinostomiya (lakodakriotsistostomiya) is applied at the dacryocystites which are followed by an obliteration of the lacrimal tubules. The top of a dacryocyst is removed through a section of a conjunctiva to the area of the lacrimal lake (lacus lacrimalis) and cut off (fig. 5). Edges of a cut hem to a conjunctiva. Further create an anastomosis between a dacryocyst and a nasal cavity. Operation can be also executed by introduction of a plastic drainage.

Lakorinostomiya offered by B. L. Polyak is shown at an obliteration of the lacrimal tubules and a dacryocyst. Consists in connection of the lacrimal lake and a nasal cavity by means of a plastic cannula prosthesis (fig. 6).

Taumi's operation consists in formation of a bone opening, opening in a mucous membrane of a nose and introduction to this opening of a rag from the made an incision wall of a dacryocyst. It is especially shown at children since at it there is no need of suture. The technique offered by V. V. Volkov and M. Yu. Sultanov (sparing the technician) allows to reduce the sizes of a bone window (to 1x1 cm) and length of a skin section.

Other modifications are used less often. Also various ways of an intubation of a nasal duct are offered. Perspective was a medial intubation, at a cut the cavity of a bag connects a cannula to the average nasal course.


Bibliography: Wolves V. V. and Sultanov M. Yu. Outside dacryocystorhinostomy, L., 1975, bibliogr.; 3 and in a yawl about in I. A. Some surgical interventions on the lacrimal ways at their obliteration, Vestn, oftalm., No. 5, page 59, 1962, bibliogr.; Margolis M. G. and Pluzhnichenko B. V. Hirurgiya of the lacrimal bodies, M., 1965, bibliogr.; Pole B. L. Povrezhdeniya of an organ of sight, page 50, L., 1972; M. Yu. Sultans. Comparative assessment of bezmolotkovy ways of formation of an opening in a bone, Vestn, oftalm., JSIa 3, page 83, 1971, bibliogr.; And of of u g a H. Occular surgery, N. Y., 1962; Dupuy-DuLemps L. Observation sur mille dacryostomies plastiques, Ann. Oculist. (Paris), t. 170, p. 361, 1933; Toti A. Zum Princip, zur Technik und zur Geschichte der Dacryo-cystorhinostomia, Z. Augenheilk., Bd 23, S. 232, 1910.

A. M. Vodovozov.

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