The importance of clinical presentation on long-term outcomes of external dacryocystorhinostomies: Our experience on 245 cases

Exploring the lacrimal sac fossa: anatomical insights for optimizing external dacryocystorhinostomy

BACKGROUND

External dacryocystorhinostomy is considered the gold standard for treating epiphora resulting from nasolacrimal duct obstruction. Despite the success of the procedure, a visible facial skin scar often undermines the surgical outcome. The aim of this study is to prevent visible facial scarring following oculoplastic interventions by improving the insight into the anatomical details of the lacrimal sac fossa (LSF), lacrimo-maxillary suture (LMS), periosteum, and lacrimal diaphragm.

METHODS

The study examined the medial canthal region of eighty adult male sspecimens to investigate the landmarks associated with the LSF. The periorbital area was dissected to reveal the skin, subcutaneous tissues, orbicularis oculi muscles, and the lacrimal drainage system, all of which were detached from their bony attachments. The lengths of the lacrimal crests, midline length, midline width, dorsolateral angle, composition of the LMS, and area of the LSF were evaluated using the ImageJ program. The LSF was categorized into six distinct shapes: ellipsoid, oval, inverted pear, straight pear, oblique hammer, and quadrangular.

RESULTS

The measurements of the anterior lacrimal crest averaged 2.2 ± 0.4 cm, the posterior edge 2.0 ± 0.4 cm, and the midline 1.9 ± 0.3 cm. The area of the LSF was found to be 1.4 ± 0.5 cm². The analysis reveals that about half of the LSF consists of equal parts maxillary and lacrimal bones. The dorsolateral angle values where the maxilla and os lacrimale equally contributed to the structure of the LSF were higher than those completely formed by the maxilla. The shapes of the LSF were classified as ellipsoid (35%), oblique hammer (21.3%), oval (13.7%), inverted pear (15%), with the ellipsoid type being the most frequent. The anterior lacrimal crest length of the oval-shaped LSF was shorter than that of the oblique hammer-shaped LSF. Similarly, the posterior lacrimal crest of the oval-shaped LSF was shorter than that of the oblique hammer-shaped LSF. The midline length of ellipsoid, oval, and inverted pear-shaped LSFs was shorter than that of oblique hammer-shaped LSFs.

CONCLUSION

The length of anterior lacrimal crest and LMS are suggested as the most reliable navigational references for locating the type of LSF. Mastery of the transversal and vertical orientation of the LSF is essential for surgeons performing oculoplastic surgeries tailored to individual anatomical variations. This study is clinically valuable as it underscores the necessity for oculoplastic surgeons to adapt surgical techniques in response to anatomical differences encountered during surgery.

External dacryocystorhinostomy: A critical overview of the current evidence

PURPOSE

External dacryocystorhinostomy (ext-DCR) is still considered the gold standard in the treatment of distal lacrimal duct obstruction. Despite an overall high success rate, some patients do relapse after surgery and the ideal perioperative management has not been identified yet. The purpose of this study is to critically discuss the published evidence in the last five years on the medical and surgical management of external dacryocystorhinostomy. Furthermore, the drawbacks of the available literature and the perspectives in this field will be also highlighted.

METHODS

Systematic review of the literature in the last 5 years by using PubMed and Google Scholar.

RESULTS

A total of 64 articles were included. Many technical modifications and surgical refinements have been proposed but a formal comparison among the various techniques is hampered by methodological heterogeneity. The use of local anesthesia, and the perioperative adjunctive techniques to reduce the risk of restenosis are also gaining popularity but the level of evidence remains weak.

CONCLUSION

Ext-DCR offers satisfactory clinical outcomes even though there are many gray areas that need to be addressed in future high-quality studies.

Analysis of the safety and effectiveness of endoscopic nasal dacryocystorhinostomy in the remedy of chronic dacryocystitis

To estimate the safety and effectiveness of endoscopic nasal dacryocystorhinostomy in the remedy of chronic dacryocystitis. The clinical data of 105 subjects with chronic dacryocystitis enrolled into our hospital were analyzed retrospectively. The subjects were distinguished into nasal endoscopic group (endoscopic dacryocystorhinostomy; i.e., 51 cases) according to their surgical methods and external-route group (external-route dacryocystorhinostomy; i.e., 54 cases). The therapeutic effect, lacrimal gland secretion function, tear film stability, degree of epiphora, lacrimal passage patency, complications, and recurrence rate were contrasted between the 2 groups. The nasal endoscopic group exhibited a higher effective remedy rate (98.04%) compared with the external-route group (83.33%). Three months postoperation, both groups showed improvements in lacrimal gland secretion function and tear film stability, with the nasal endoscopic group demonstrating more significant enhancement in lacrimal gland secretion function than the external-route group. Six months postoperation, a reduction in the degree of epiphora was observed in both groups, with the nasal endoscopic group displaying a more pronounced decrease in epiphora severity and a higher lacrimal passage patency rate than the external-route group. Furthermore, the nasal endoscopic group experienced lower incidences of postoperative complications and recurrence rates. Endoscopic dacryocystorhinostomy is safe and effective in the remedy of chronic dacryocystitis.