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Surgical anatomy of the lacrimal fossa a prospective computed tomodensitometry scan analysis.

Abstract：

PURPOSE:To establish the accurate surgical anatomy of endonasal dacryocystorhinostomy (DCR) based on the radiological analysis of underlying bony structures. DESIGN:Prospective noncomparative observational case series study. PARTICIPANTS:Fifty-nine patients with complete nasolacrimal stenosis underwent a computed tomodensitometry (CT) scan before endonasal DCR. METHODS:High-resolution CT scanning with contrast injection of the lacrimal sac was performed. Image reconstruction was performed to obtain continuous 1.0-mm axial and coronal sections for review. MAIN OUTCOME MEASURES:Relationship of the lacrimal fossa (LF) to the operculum of the middle turbinate (OMT), the uncinate process (UP), and the frontal recess (FR); symmetry of the right and left anatomies; location of the OMT; position of the most anterior insertion of the UP with respect to 2 main references (the posterior lacrimal crest and the junction between the maxillary and lacrimal bones) on axial sections at 3 different levels (upper, intermediate, and lower of the LF); height of the LF; and distance of the OMT from the lower limit of the LF. RESULTS:The OMT, the UP, and the FR were adjacent to the LF in 41 (53.2%), 73 (94.8%), and 23 cases (29.9%), respectively. There was a right-left symmetry in 10 of 18 patients (55%). The OMT was always anterior to the junction between the maxillary bone and the lacrimal bone. The UP was more frequently posterior (32.5%) or adjacent (45.5%) to the LF at the lower level, adjacent to the maxillary bone (55.8%) at the intermediate level, and adjacent to the middle turbinate (61%) at the upper level. The height of the LF was 12.06+/-1.93 mm. The OMT was located 5.96+/-2.05 mm upward from the lower limit of the LF. CONCLUSION:The almost constant overlapping of the UP onto the LF at the level of the common canaliculus indicates that the most effective approach for successful DCR osteotomy is via a submucosal cleavage and resection of the anterior part of the UP. The management of these landmark structures should be an integral part of the endonasal DCR method.

journal_name

Ophthalmology

journal_title

Ophthalmology

authors

Fayet B,Racy E,Assouline M,Zerbib M

doi

10.1016/j.ophtha.2005.01.012

subject

Has Abstract

pub_date

2005-06-01 00:00:00

pages

1119-28

issue

eissn

0161-6420

issn

1549-4713

pii

S0161-6420(05)00118-1

journal_volume

112

pub_type

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Surgical anatomy of the lacrimal fossa a prospective computed tomodensitometry scan analysis.