Anat Cell Biol.  2021 Dec;54(4):441-447. 10.5115/acb.21.081.

Anatomy of lacrimal sac fossa affecting success rate in endoscopic and external dacryocystorhinostomy surgery in Mongolians

• Purevdorj B
• Dugarsuren U
• Tuvaan B
• Jamiyanjav B

• KMID: 2523575
• DOI: http://doi.org/10.5115/acb.21.081

Abstract

To study the affect of anatomical variance of lacrimal sac fossa on dacryocystorhinostomies (DCR) performed by the traditional external (EX-DCR) approach or an endoscopic (EN-DCR) endonasal approach. A total of 292 consecutive cases with primary nasolacrimal obstruction underwent DCR surgery. Orbital computed tomography scan was used to measure lacrimal sac fossa and other related structures and Lac-Q questionnaire was used to compare surgery result. Maxillary portion of lacrimal sac fossa is thicker in failed surgery group than successful surgery group (P<0.05). Lateral nasal structures (uncinate process, operculum of the middle turbinate, agger nasi) are dominantly adjusting to lacrimal sac fossa in failed surgery group (P<0.05). Patients who underwent EX-DCR has a 6.0-point and EN-DCR group 11.0-point improvement (P<0.016) in Lac-Q questionnaire. Patients who have a thick frontal process of the maxilla and uncinate process, operculum of the middle turbinate, ethmoid cells adjusting to lacrimal fossa are prone to have recurrence of nasolacrimal duct obstruction after DCR surgery. The EN-DCR and the EX-DCR approach have an equivalent surgical success rate but improvement in quality of life by using the Lac-Q questionnaire is greater in the endoscopic group when compared with the external.

Keyword

Lacrimal sac fossa; Nasolacrimal duct obstruction; Endoscopic dacryocystorhinostomy; External dacryocystorhinostomy

Figure

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  Fig. 1 Axial plane of computed tomography scan. This section showing the lower level of lacrimal fossa and other structures around this. Lacrimal fossa consists of maxilliary bone (MB, yellow) and lacrimal bone (LB, green) and these 2 bones connect at anterior lacrimal crest (MB-LB). In this case the location of the anterior insertion of the uncinate process (UP) is anterior to the posterior lacrimal crest (PLC) and posterior to the maxillary bone. LS, lacrimal sac; MT, middle turbinate; S, septum.

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  Fig. 2 Axial plane of computed tomography scan showing the relationship of the lacrimal fossa (starred) and uncinate process (UP; arrow). (A) UP is inserted onto the lacrimal bone in the lower level. (B) UP is inserted onto the maxillary bone in the middle level. (C) UP is inserted onto the lateral wall of the middle turbinate (MT) in the lower level.

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  Fig. 3 Coronal computed tomography scan showing the relationship of the lacrimal fossa (LF) and agger nasi (AN) cell. In this case variation of AN cell that is adjacent to the lacrimal sac fossa was presented. MS, maxilliary sinus; IT, inferior turbinate; MT, middle turbinate; FD, frontal duct.

Reference

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