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Endoscopic Dacryocystorhinostomy (right nasal cavity).

1.Mucosal incisions at the region of the lacrimal sac. 2. Elevation of the mucosal flap.
3. Removal of the soft lacrimal bone with a Freer elevator. 4. Removal of the hard bone of the frontal process with a Hajek punch.
5. Continuing the revealing of the lacrimal sac with the punch. 6. Removal of the anterior wall of the agger nasi cell and opening of the mucosa.
7. Completion of the uncovering of the lacrimal sac with a diamond burr. 8. Opening the lacrimal sac after probing the inferior punctum.
9. Creation of a large anterior flap and … 10. ...a small posterior flap to approximate the mucosa of the agger nasi cell.
11. Grasping the probe with a forceps and removing from the nasal cavity. 12. Dilatation of the superior punctum and insertion of the other end of the probe.
13. A silastic tube is slid over the lacrimal tubes. 14. Checking the loop in the medial canthus.
15. Securing the tube with clips. 16. Trimming the original mucosal flap to secure the flaps of the lacrimal sac.
17. The final shape of the mucosal flap. 18. Placing the limbs of the mucosal flap around the silastic tube.
19. Securing the flaps with absorbable material.