Korean J Radiol.  2016 Apr;17(2):271-276. 10.3348/kjr.2016.17.2.271.

Morphometric Evaluation of Bony Nasolacrimal Canal in a Caucasian Population with Primary Acquired Nasolacrimal Duct Obstruction: A Multidetector Computed Tomography Study

• Bulbul E
• Yazici A
• Yanik B
• Yazici H
• Demirpolat G

• KMID: 2360213
• DOI: http://doi.org/10.3348/kjr.2016.17.2.271

Abstract

OBJECTIVE
The bony nasolacrimal duct (BNLD) morphology as a contributory factor in primary acquired nasolacrimal duct obstruction (PANDO) is still controversial. The objectives of this study were to evaluate the morphometric differences of BNLDs in unilateral PANDO patients between PANDO and non-PANDO sides, as compared with the control group using multidetector computed tomography (CT).
MATERIALS AND METHODS
Bilateral BNLDs in 39 unilateral PANDO patients and 36 control subjects were retrospectively reviewed. CT images with 0.5-mm thickness were obtained with a 64-slice scanner. The length, volume, coronal orientation type, sagittal orientation angle of BNLD, and relative lacrimal sac-BNLD angle were assessed. The entrance, minimum and distal end transverse diameters (TD) of BNLD was investigated.
RESULTS
The mean minimum and distal end BNLD TDs measurements were significantly narrower in PANDO patients, both in PANDO and non-PANDO sides, as compared with the control group (p < 0.001 and p = 0.040, respectively); however, there were no significant differences between PANDO and non-PANDO sides within PANDO patients. The length, entrance TD, volume, coronal orientation type, sagittal orientation angle of BNLD, and relative lacrimal sac-BNLD angle were not significantly different between PANDO patients and control subjects, as well as between PANDO and non-PANDO sides within PANDO patients.
CONCLUSION
The narrow mean minimum and distal end BNLD TD in PANDO patients, in both PANDO and non-PANDO sides, may be associated with PANDO development. The lack of difference between PANDO and non-PANDO sides within PANDO patients and some overlap between PANDO patients and control subjects suggest that narrow BNLD is not the sole factor.

Keyword

Bony nasolacrimal duct; Computed tomography; Nasolacrimal duct obstruction

MeSH Terms

Adult
Aged
Case-Control Studies
Female
Humans
Lacrimal Duct Obstruction/diagnosis/*radiography
Male
Middle Aged
*Multidetector Computed Tomography
Nasolacrimal Duct/*radiography
Retrospective Studies

Figure

• 

  Fig. 1 BNLD measurements with multidetector CT. Sagittal CT image (A) reveals BNLD length (white line) measurement. Axial CT image (B) in bone window demonstrates BNLD TD measurement (white lines). Sagittal CT image (C) shows outlining of BNLD (black line) for BNLD volume calculation. Coronal CT image (D) reveals determination of coronal orientation type. Coronal orientation type is called "inward" (i) if long axis of BNLD (dashed arrow at right side) is medially to coronal plane (arrow) and towards midline (open line). It is called "outward" (o), if long axis of BNLD (dashed arrow at left side) is laterally to coronal plane (arrow) and outwards to midline. Sagittal CT image (E) demonstrates measurement of sagittal orientation angle (a) between long axis (white arrow) of BNLD and nasal floor (black arrow). Coronal CT image in soft tissue window (F) shows relative lacrimal sac-BNLD orientation angle (a) between long axis of lacrimal sac (black arrow) and BNLD (white arrow), respectively. BNLD = bony nasolacrimal duct, CT = computed tomography, TD = transverse diameter

Reference

1. Ohtomo K, Ueta T, Toyama T, Nagahara M. Predisposing factors for primary acquired nasolacrimal duct obstruction. Graefes Arch Clin Exp Ophthalmol. 2013; 251:1835–1839.

2. Linberg JV, McCormick SA. Primary acquired nasolacrimal duct obstruction. A clinicopathologic report and biopsy technique. Ophthalmology. 1986; 93:1055–1063.

3. Seider N, Miller B, Beiran I. Topical glaucoma therapy as a risk factor for nasolacrimal duct obstruction. Am J Ophthalmol. 2008; 145:120–123.

4. Janssen AG, Mansour K, Bos JJ, Castelijns JA. Diameter of the bony lacrimal canal: normal values and values related to nasolacrimal duct obstruction: assessment with CT. AJNR Am J Neuroradiol. 2001; 22:845–850.

5. Shigeta K, Takegoshi H, Kikuchi S. Sex and age differences in the bony nasolacrimal canal: an anatomical study. Arch Ophthalmol. 2007; 125:1677–1681.

6. McCormick A, Sloan B. The diameter of the nasolacrimal canal measured by computed tomography: gender and racial differences. Clin Experiment Ophthalmol. 2009; 37:357–361.

7. Takahashi Y, Nakata K, Miyazaki H, Ichinose A, Kakizaki H. Comparison of bony nasolacrimal canal narrowing with or without primary acquired nasolacrimal duct obstruction in a Japanese population. Ophthal Plast Reconstr Surg. 2014; 30:434–438.

8. Estes JL, Tsiouris AJ, Christos PJ, Lelli GJ. Three-dimensional volumetric assessment of the nasolacrimal duct in patients with obstruction. Ophthal Plast Reconstr Surg. 2015; 31:211–214.

9. Ramey NA, Hoang JK, Richard MJ. Multidetector CT of nasolacrimal canal morphology: normal variation by age, gender, and race. Ophthal Plast Reconstr Surg. 2013; 29:475–480.

10. Takahashi Y, Nakamura Y, Nakano T, Asamoto K, Iwaki M, Kakizaki H. Horizontal orientation of the bony lacrimal passage: an anatomical study. Ophthal Plast Reconstr Surg. 2013; 29:128–130.

11. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977; 33:159–174.

12. Groessl SA, Sires BS, Lemke BN. An anatomical basis for primary acquired nasolacrimal duct obstruction. Arch Ophthalmol. 1997; 115:71–74.

13. Groell R, Schaffler GJ, Uggowitzer M, Szolar DH, Muellner K. CT-anatomy of the nasolacrimal sac and duct. Surg Radiol Anat. 1997; 19:189–191.

14. Russell EJ, Czervionke L, Huckman M, Daniels D, McLachlan D. CT of the inferomedial orbit and the lacrimal drainage apparatus: normal and pathologic anatomy. AJR Am J Roentgenol. 1985; 145:1147–1154.

15. Kashkouli MB, Sadeghipour A, Kaghazkanani R, Bayat A, Pakdel F, Aghai GH. Pathogenesis of primary acquired nasolacrimal duct obstruction. Orbit. 2010; 29:11–15.

16. Narioka J, Matsuda S, Ohashi Y. Correlation between anthropometric facial features and characteristics of nasolacrimal drainage system in connection to false passage. Clin Experiment Ophthalmol. 2007; 35:651–656.