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Intraoperative Instrument Fracture During Endoscopic Dacryocystorhinostomy

Ali, Mohammad Javed F.R.C.S.; Naik, Milind N. M.D.

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Ophthalmic Plastic & Reconstructive Surgery: January/February 2017 - Volume 33 - Issue 1 - p e27
doi: 10.1097/IOP.0000000000000650
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Intraoperative instrument breakage is not common and has been mostly reported in the orthopedic literature to range from 0.18% to 0.35%. A female patient, aged 27 years, underwent an endoscopic dacryocystorhinostomy for right sided primary acquired nasolacrimal duct obstruction. The frontal process of maxilla (“M” in Fig. 1A) was very thick superiorly and hence the superior osteotomy was being fashioned using the 2.5 mm, 15° curved, high speed DCR burr (Medtronic, Jacksonville, FL). Half way through the osteotomy, there was a sudden breakage of the drill bit between the distal 1/3 and proximal 2/3. The distal bit with the Diamond Head remained partly embedded in the frontal process (Fig. 1A) with the distorted breakage point (Fig. 1A, black arrowhead) in contact with the septal mucosa without any trauma within the nasal cavity. The distal broken end was gently retrieved using the Blakesley’s straight forceps. A little amount of scattered metal debris (Fig. 1B, black arrowheads) were noted and removed. There was no trauma to the lacrimal sac (“L” in Fig. 1B). Examination of the fractured instrument (Fig. 1C) showed the sites of the fracture on proximal (P) and distal (D) segments of the drill bit and the dislocation of the adjacent metallic irrigation (I) port (Fig. 1C). As per the scant literature and guidelines available currently, this was documented in the operating room incident log book to ascertain the possible causes and a report is being prepared to be sent to the manufacturers.

FIG. 1
FIG. 1:
Intraoperative DCR burr breakage.A, Endoscopic picture of the right nasal cavity showing the fractured distal segment of the drill bit. Note the thick frontal process of M and the distorted breakage end (black arrowhead). B, Endoscopic view showing the scattered metallic debris (black arrowheads) and the unharmed L sac. C, The fractured DCR burr, showing the P segment, D segment, and the dislocated I port. D, distal; I, irrigation; L, lacrimal; M, maxilla; P, proximal.
© 2017 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.