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    Long-Term Results of Simultaneous Bilateral External Dacryocystorhinostomy in Cases with Bilateral Dacryostenosis
    (INFORMA HEALTHCARE, 2015) Yuksel, Dilek; Kosker, Mustafa; Akoz, Irem; Simsek, Saban
    Objectives: To evaluate the long-term results of simultaneous bilateral external dacryocystorhinostomy (EX-DCR) in cases with bilateral dacryostenosis. Methods: Thirty-four eyes of 17 consecutive patients with a history of bilateral epiphora were included in the study between 2007 and 2011. Demographic information, etiology of the obstruction, history of lacrimal surgery, type of anesthesia, duration of surgery, incidence of postoperative nasal bleeding and infection, surgical outcomes, and duration of follow-up were recorded. During the lacrimal irrigation, there was not any passage noticed in the patients' eyes. The post-operative follow-up was 13 to 44 months (mean 33.6 months). Results: Of 17 patients undergoing simultaneous bilateral EX-DCR with a mean age of 42.8 years, one of the patients had a history of bilateral unsuccessful DCR performed in a different center. One patient had previously failed bilateral probing before undergoing bilateral EX-DCR. This latter patient was a four-month-old baby with bilateral dacryoceles. Bicanalicular silicone intubation was performed in 15 eyes of 10 patients that had a canalicular problem or fibrotic lacrimal sac. It has been discerned that complaints about epiphora disappeared in 33 of the eyes (97%) and that the passage was open during the lacrimal irrigation. One eye with a history of unsuccessful dacryocystorhinostomy failed to respond positively to our operation. Conclusions: In our study, high success rates of simultaneous bilateral EX-DCR were found in both children and adult patients with bilateral dacryostenosis during a long-term follow-up. We believe that simultaneous bilateral dacryocystorhinostomy has medical, social, and economic advantages.
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    Surgical Treatment of Mucoepidermoid Carcinoma of the Lacrimal Sac
    (INFORMA HEALTHCARE, 2014) Yuksel, Dilek; Kosker, Mustafa; Saribas, Ferhat; Simsek, Saban
    Purpose: We report successful management of a case with high-grade mucoepidermoid carcinoma of the lacrimal sac managed by aggressive soft tissue and bony resection with adjuvant radiotherapy. Methods: Case report. Results: A 32-year-old man was referred to us with a two-year history of epiphora and slow-growing mass in the area of the lacrimal sac. On physical examination, a firm and nontender mass was visible overlying the area of the right lacrimal sac. Computed tomography and magnetic resonance imaging confirmed a 30 mm x 15 mm, well-enhanced soft tissue mass occupying the lacrimal fossa and extending to include the nasolacrimal duct, and FNA biopsy of the mass demonstrated high-grade mucoepidermoid carcinoma. On this basis, the tumor, lacrimal sac, and nasolacrimal duct were removed en bloc with the frontal process of the maxilla, lateral nasal wall, lacrimal fossa, ethmoids, and anterior part of the medial orbital wall with two intraoperative frozen section examinations. Postoperatively, the patient received adjuvant radiotherapy. The clinical evaluation and positron emission tomography at 38 months showed recovery and no recurrence of the disease. Conclusions: MEC of the lacrirnal sac is extremely rare and spreads locally in an aggressive manner. Despite the fact that orbital exenteration have generally been recommended for these tumors, radical surgical resections with external radiation therapy might be effective. In our case, despite the high-grade MEC, the patient underwent successful radical surgical excision and postoperative adjuvant external radiotherapy. As a result, we achieved an aesthetically satisfying result by preserving the eye and the vision.