Kosin Med J.  2018 Dec;33(3):358-368. 10.7180/kmj.2018.33.3.358.

Correlation between nasal mucosal thickness around the lacrimal sac fossa and surgical outcomes in endonasal dacryocystorhinostomy

• Yoo JH
• Kim CZ
• Nam KY
• Lee SU
• Lee JH
• Lee SJ

• KMID: 2442546
• DOI: http://doi.org/10.7180/kmj.2018.33.3.358

Abstract

OBJECTIVES
To identify the relationship between surgical success rate and preoperative nasal mucosal thickness around the lacrimal sac fossa, as measured using computed tomography.
METHODS
We reviewed 33 eyes from 27 patients who underwent endoscopic dacryocystorhinostomy after diagnosis of primary nasolacrimal duct obstruction and who were followed-up with for at least six months between 2011 and 2014. We measured preoperative nasal mucosal thickness around the bony lacrimal sac fossa using computed tomography and analyzed patient measurements after classifying them into three groups: the successfully operated group, the failed operation group, and the non-operated group.
RESULTS
Surgery failed in six of the 33 eyes because of a granuloma at the osteotomy site and synechial formation of the nasal mucosa. The failed-surgery group showed a clinically significantly greater decrease in nasal mucosal thickness at the rearward lacrimal sac fossa compared with the successful-surgery group. However, nasal mucosal thickness of fellow eyes (i.e., non-operated eyes) was not significantly different between the two groups, and the location of the uncinate process did not appear to influence mucosal thickness. In the failed group, posteriorly located mucosal thickness of operated eye fossa was thinner than that of the non-operated eyes, but not significantly so.
CONCLUSIONS
Our results from this quantitative anatomical study suggest that nasal mucosal thickness is a predictor of endoscopic dacryocystorhinostomy results.

Keyword

Computed tomography; Endoscopic dacryocystorhinostomy; Nasal mucosal thickness

MeSH Terms

Dacryocystorhinostomy*
Diagnosis
Granuloma
Humans
Nasal Mucosa
Nasolacrimal Duct*
Osteotomy

Figure

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  Fig. 1 The CT images of nasal mucosa and bony structure. A) Measurement of nasal mucosal thickness around the bony nasolacrimal duct, classified into anterior, middle, posterior areas. Lines indicate the anterior, middle, and posterior borders of the bony nasolacrimal duct. Uncinate processes located B) anterior and C) posterior to the bony nasolacrimal duct. Arrows indicate an uncinate process.

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  Fig. 2 The images of surgical failure EN-DCR due to ostium closure. A) Arrow indicates granuloma in the ostium. B) Arrow indicates synechiae with nasal mucosa around the ostium.

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  Fig. 3 The graph of mean mucosal thicknesses around lacrimal fossa of all patients. A) Comparison of mucosal thickness around the lacrimal fossa of operated eyes between the successful and failed groups. Only the posterior lacrimal fossa mucosa was significantly different. B) Comparison of mucosal thicknesses around the lacrimal fossa of non-operated eyes between the successful and failed groups. There were no significant differences at any location between the successful and failed groups. C) Comparisons of mucosal thickness of the operated eyes according to location of uncinate processes in the total patient group. D) Comparisons of mucosal thickness of the operated eyes according to location of uncinate processes in the total patient group.

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