Influence of the Middle Nasal Meatus Anatomy on the Outcomes of Various Osteotomy Techniques in Endoscopic Dacryocystorhinostomy

Рurpose. Comparative analysis of the results of endoscopic endonasal dacryocystorhinostomy (EEDCR) using a high-speed drill and a piezosurgical device, assessing the impact of the degree of middle meatus narrowing on the complication rate and functional success.
Material and methods. This retrospective cohort study included 240 patients with obstruction of the vertical portion of the lacrimal drainage system, divided into two equal groups depending on the osteotomy method (drill vs. piezosurgery). Based on preoperative CT, all patients were stratified by the degree of middle meatus narrowing: grade I (>4 mm), grade II (≤4 mm), grade III (≤2 mm). The groups were comparable in anatomical characteristics. Outcomes were assessed 6 months after surgery.
Results. The use of piezosurgery significantly reduced the incidence of intraoperative bleeding (p ≤ 0.01), synechiae (p = 0.040), granulations (p = 0.035), and ostium closure (p = 0.049). The recurrence rate in the piezosurgery group was 3.2 % versus 10.0 % in the drill group (p ≤ 0.05). Subgroup analysis demonstrated that the greatest differences between the methods were achieved in patients with grade III narrowing (≤2 mm), where the risk of iatrogenic mucosal injury and subsequent scarring is highest. The selectivity of ultrasonic impact, which preserves soft tissue integrity, prevents the formation of a “wound mirror” and the development of the synechial process.
Conclusion. Piezosurgical osteotomy is the preferred method for primary EEDCR in patients with a narrow middle meatus (grade II–III narrowing), providing a significant reduction in the rate of complications and recurrence of epiphora.

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