METHOD OF PLASTIC SURGERY OF NASOLACRIMAL FISTULA DURING ENDONASAL ENDOSCOPIC DACRYOCYSTORHINOSTOMY Russian patent published in 2008 - IPC A61F9/00 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to ophthalmology, and can be applied during surgical treatment of dacriocystitis and stenosis of nasolacrimal duct by means of plastic surgery of nasolacrimal fistula. Essence of invention is in plastic surgery of nasolacrimal fistula during endonasal endoscopic dacryocystorhinostomy. Anesthetisation is performed; rigid endoscope, connected with video camera, is introduced into nasal cavity. Then "П"-shaped flap is cut out from mucous membrane of lateral wall of nasal cavity in region of projection of lacrimal sac - in front of the place of medium nasal turbinate attachment. Flap is tuned downwards. Then bone window is formed in frontal process of maxilla and in lacrimal bone in region of cut-out flap projection and of the same size as flap. By means of operating tip of radio-wave apparatus "Surgitron", "П"-shaped flap is formed from anterior-medial section of lacrimal sac wall, with its base to bottom and of the same size as bone window, then turned downwards. After that content of sac is evacuated by aspiration. Then cut-out flaps of lacrimal flap and nasal mucous membrane are matched and connected by application of microsurgical sutures on edge tissue of flaps, using microsurgical needle-holder, introduced endonasally. Cutting-out of flaps is realised by means of radio-wave apparatus of model "Surgitron-DF 120" with wave frequency 4 MHz. For cutting-out nasal mucous membrane flap, L-shaped electrode is used, and for cutting-out lacrimal sac, flap needle electrode is used, whose needle length is set each time depending on thickness of lacrimal sac in region of dissection. Before cutting-out flap, sac is filled with viscoelastic substance through lacrimal tubule, and by the same way retinal gripping forceps are introduced into sac, which are used bimanually with instruments introduced endonasally during cutting-out flap from sac wall, matching flaps and application of sutures.

EFFECT: reduction of operation duration, terms of rehabilitation and number of post-operation complications in surgical treatment of dacryocystitis and stenosis of nasolacrimal duct.

4 cl, 1 ex