Fig. 1.

(A) A nasal mucosal flap is being elevated after a reverse "C" shaped incision on the mucosa of the lateral nasal wall with slit knife just anterior to the insertion of middle turbinate. (B) The maxillary bone covering the lacrimal sac is drilled out with a curved diamond dacryocystorhinostomy bur (15°, 2.9 mm, Xomed Co., Jacksonville, Florida, U.S.A.). (C) The extent of the lacrimal sac is verified with lacrimal probe (arrow) and the sac wall is tented to allow incision. The vertical incision is made with a slit knife. (D) The mucosal flap covers the exposed bony portion after cutting and trimming. The edges of the exposed lacrimal sac (arrow) are everted to match the nasal mucosa and the sac lumen is filled with gelfoam (asterisk) to keep the flap anastomosis in position. A silicone bicannalicular tube is seen through the new opening. LNW, lateral nasal wall; MT, middle turbinate; S, septum; LS, lacrimal sac; MF, mucosal flap.