A Comparison of Surgical Outcomes between Small Fenestra and Large Fenestra Endoscopic Endonasal Dacryocystorhinostomy

Objective: Endoscopic endonasal DCR is a well established technique but, there has been considerable debate in the literature about the size of the neo-ostium made during the surgery.Materials: Between September 2005 and February 2008, 22 patients (30 sides) with persistant epiphora and/or chronic dacryocystitis underwent endoscopic DCR. They were 8 males and 14 females aged between 21 and 58 years (mean 44.3 years). The included patients were divided randomly into two equal groups each included 11 patients. Group A patients were treated with small fenestra endoscopic DCR while the group B patients were treated with large fenestra endoscopic DCR. Results: The mean follow up period was 18.7 months (range 12-27 months). Of 15 sides in each group, 12 sides (80%) in group A and 14 sides (93.3%) in group B demonstrated primary surgical success, defined as absence of epiphora. Obstruction of the neo-ostium by fibrous tissue or synechia was identified in 3 cases (2 in group A and 1 in group B). While one case in group A complained persistence of epiphora in the presence of patent neo ostium. This case was considered a surgical failure. Conclusions: This study demonstrates that small and large fenestra techniques are safe and effective in the management of chronic dacryocystitis. Although the large fenestra endoscopic DCR showed better outcome compared with small fenestra technique, it was statistically insignificant.