ENDOSCOPIC CDCR скачать в хорошем качестве

ENDOSCOPIC CDCR

#nose #ear #throathealth #science #ent #otolaryngology #nosebleed #tonsils #biology #anatomy Endoscopic Conjunctivodacryocystorhinostomy, or CDCR, is a specialized procedure utilized when standard endoscopic or external dacryocystorhinostomy (DCR) methods fail. Before resorting to this approach, it is essential to assess and address possible proximal causes of lacrimal obstruction, such as punctal or canalicular stenosis, which may contribute to the underlying condition. In cases where these obstructions persist, CDCR becomes necessary to bypass the blockage effectively. This procedure involves the use of a Jones tube, a specialized glass tube designed to maintain a permanent conduit for tear drainage. The surgical process begins with the resection of the caruncle, a fleshy mound of tissue located at the medial canthus, or the inner corner of the eye. Following this, a 14-gauge angiocatheter or blunt needle is employed to create an opening through the conjunctiva. This step is executed at a precise 45-degree angle into the nasal cavity using what is known as the ‘poke-through’ technique. The accuracy of this angle is critical to ensure the catheter enters the nasal cavity correctly without complications. Once the catheter penetrates the lacrimal sac and lateral nasal wall, it is identified intranasally with the aid of an endoscope. This visualization ensures that the catheter is appropriately placed and not obstructed. It is vital to guide the catheter anteriorly to the middle turbinate to prevent it from becoming lodged against the turbinate surface, which could compromise the procedure’s success. After establishing a conduit from the medial conjunctiva to the nasal cavity, the next step involves the use of lacrimal dilators to expand the newly created tract. This process ensures that the pathway is adequately sized to accommodate the Jones tube. The Jones tube is then carefully passed through the established tunnel, ensuring that its distal end extends at least 2 millimeters beyond the lateral nasal wall into the nasal cavity. These Pyrex glass tubes come in a variety of diameters and lengths, allowing customization to suit the patient’s unique anatomy. The selection of an appropriately sized tube is critical to ensure that the conduit remains patent, or open, over the long term. A tube that is too small may fail to provide adequate stenting, leading to a recurrence of obstruction. The success of the procedure depends on several factors, including precise surgical technique, proper placement of the Jones tube, and careful postoperative management. Patients may require follow-up care to monitor the tube’s position and ensure it continues to function as intended. When performed correctly, CDCR with a Jones tube can provide significant relief for patients suffering from chronic lacrimal obstruction, restoring normal tear drainage and improving their quality of life.” This expanded script provides additional details about the importance of each step, the role of postoperative care,