RHINOLOGY Endonasal endoscopic dacryocystorhinostomy: how to achieve optimal results with simple punch technique Mohsen Naraghi • Sayed Ziaeddin Tabatabaii Mohammadi • Alain Fabrice Sontou • Armin Farajzadeh Deroee • Masoud Boroojerdi Received: 15 December 2010 / Accepted: 27 October 2011 / Published online: 8 November 2011 Ó Springer-Verlag 2011 Abstract Endonasal endoscopic dacryocystorhinostomy (EEDCR) has been popularized as a minimally invasive technique. Although preliminary reports revealed less success in comparison with external approaches, recent endonasal endoscopic surgeries on various types of DCR have preserved advantages of this technique while dimin- ishing the failures. We described our experience on EED- CR, including the main advantages and disadvantages of it. Hundred consecutive cases of lachrymal problems under- went EEDCR utilizing simple punch removal of bone, instead of powered instrumentation or lasers. The medial aspect of the sac was removed in all of patients, while preserving normal mucosa around the sac. Hundred cases of EEDCR were performed on 81 patients, with 19 bilateral procedures. Nine procedures were performed under local anesthesia. Based on a mean 14 months follow-up, 95 cases were free of symptoms, revealing 95% success rate. The punch technique diminishes the expenses of powered or laser instrumentation with comparable results. It seems that preserving normal tissues and creating a patent rhi- nostomy with least surgical trauma and less subsequent scar, plays the most important role in achieving desirable results. Keywords Endonasal Á Endoscopic Á Dacryocystorhinostomy Á Punch Á Lacrimal Á Nasolacrimal duct Introduction Dacryocystorhinostomy (DCR) is a procedure used to create a lacrimal drainage pathway into the nasal cavity to reestablish the permanent drainage of a previously obstructed excretory system. External dacryocystorhinos- tomy is the traditional treatment of nasolacrimal duct obstruction with a success rate varying from 82 to 99%. However, it has the disadvantages of facial scar, excessive intra-operative bleeding and disruption of medial canthus anatomy; therefore, there has been widespread interest in searching for alternative procedures [1–3]. Endonasal or transnasal approach described over a century ago [4] and combined with improvements in technology allowing impressive intranasal visualization and manipulation with the use of nasal endoscope, has led the way forward in usage of endonasal approaches to create a rhinostomy which allows drainage of tears [5–7]. Recently, the endonasal approach seems to reach success rate comparable to external route [8, 9]. Endonasal This manuscript was presented as ‘‘keynote lecture’’ in the 1st Congress of the Confederation of European Otorhinolaryngology and Head and Neck Surgery in Barcelona, July 2011. M. Naraghi Á S. Z. Tabatabaii Mohammadi Á A. F. Sontou Á A. Farajzadeh Deroee Á M. Boroojerdi Rhinology Research Society, Tehran, Iran M. Naraghi Division of Rhinology and Facial Plastic Surgery, Department of Otorhinolaryngology, Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran M. Naraghi Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran M. Naraghi (&) No. 2417, Valiasr Avenue, 15178 Tehran, Iran e-mail: info@naraghi.ir S. Z. Tabatabaii Mohammadi Department of Ophthalmology, Tehran University of Medical Sciences, Tehran, Iran 123 Eur Arch Otorhinolaryngol (2012) 269:1445–1449 DOI 10.1007/s00405-011-1825-2