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Shahryari S, Hanafi MG, Kamankesh R, Mahdianrad A, Moghadam ARE. Computed tomographic assessment of the lacrimal sac fossa in southwest population of Iran. Anat Cell Biol 2022; 55:277-283. [PMID: 35942868 PMCID: PMC9519764 DOI: 10.5115/acb.22.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 04/15/2022] [Accepted: 05/11/2022] [Indexed: 11/27/2022] Open
Abstract
To determine the morphology of the lacrimal sac fossa and bony nasolacrimal duct using computed tomography for obtaining detailed anatomical understanding of the drainage system and utilizing these measurements in planning for dacryocystorhinostomy (DCR) and nasolacrimal duct (NLD) obstruction in normal southwest (SW) population of Iran. One-hundred-sixty-five cases referred for the diagnosis of neuro-ophthalmic conditions were retrospectively studied. Measurements of lacrimal sac fossa were taken on three anatomical sections (upper, middle, and lower planes) utilizing a digital caliper/protractor instrument. Lacrimal thickness and two measurements of maxillary bone thickness were taken at each plane—namely, the “midpoint thickness” and the “maximum thickness.” The anterior extent of the nasal mucosa and NLD width was also evaluated. The mean maximum thickness of the maxillary bone at the three anatomical planes of the lacrimal sac fossa was 4.07 mm, 4.78 mm, and 5.60 mm, respectively. The midpoint thickness of the maxillary bone at each plane was 2.38 mm, 1.99 mm, and 1.68 mm, respectively, in both sexs. The lacrimal bone thickness at each level was 0.76 mm, 0.69 mm, and 0.67 mm, respectively. The proportion of the lacrimal sac fossa comprising the lacrimal bone at lower plane was 43.57% and showed a positive correlation with age (P=0.01). The mean anteroposterior bony nasolacrimal diameter was 5.94 mm with no significant difference between patient sex and age. According to the results, its indicate that performing an osteotomy during DCR could be easier in the Iranian SW population compared to other ethnics.
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Affiliation(s)
- Samad Shahryari
- Department of Radiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Ghasem Hanafi
- Department of Radiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Rouhangiz Kamankesh
- Department of Radiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Atefeh Mahdianrad
- Department of Ophthalmology, Faculty of Medicine, Infectious Ophthalmic Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Reza Eftekhari Moghadam
- Department of Anatomical Sciences, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Lacrimal drainage anatomy in the Japanese population. Ann Anat 2019; 223:90-99. [DOI: 10.1016/j.aanat.2019.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 01/29/2019] [Accepted: 01/29/2019] [Indexed: 11/17/2022]
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Sarbajna T, Takahashi Y, Valencia MRP, Ito M, Nishimura K, Kakizaki H. Computed tomographic assessment of the lacrimal sac fossa in the Japanese population. Ann Anat 2019; 224:23-27. [PMID: 30953810 DOI: 10.1016/j.aanat.2019.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 02/25/2019] [Accepted: 03/11/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To analyze the morphology of the lacrimal sac fossa in the Japanese population using computed tomographic images. MATERIALS AND METHODS One-hundred-fifty-five Japanese patients diagnosed with unilateral orbital fracture were retrospectively reviewed. Measurements of the dimensions of the lacrimal sac fossa were taken on three anatomical planes (upper, middle, and lower planes) using a digital caliper/protractor tool. RESULTS The mean maximum thickness of the maxillary bone at the upper, middle, and lower planes of the lacrimal sac fossa were 4.60 mm, 5.07 mm, and 6.30 mm, respectively. The midpoint thickness of the maxillary bone at each plane were 3.04 mm, 3.00 mm, and 2.17 mm, respectively. The lacrimal bone thickness at each plane were 1.13 mm, 1.13 mm, and 1.08 mm, respectively. The proportion of the lacrimal sac fossa comprising of the lacrimal bone at each plane were 39.00%, 42.05%, 38.92%, respectively. On the middle plane, the mean angle between the lacrimal bone and sagittal plane was 131.92°. CONCLUSIONS In Japanese patients, the proportion of the lacrimal bone on the lacrimal sac fossa tended to be of greater proportion compared to studies done on other races. The mean angle of the lacrimal sac fossa seemed to be comparatively high. These results indicate that performing an osteotomy during dacryocystorhinostomy could be relatively easier in the Japanese population compared to other races.
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Affiliation(s)
- Tushar Sarbajna
- Department of Oculoplastic, Orbital, and Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Yasuhiro Takahashi
- Department of Oculoplastic, Orbital, and Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan.
| | - Ma Regina Paula Valencia
- Department of Oculoplastic, Orbital, and Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Makoto Ito
- Department of Radiology, Aichi Medical University, Aichi, Japan
| | - Kunihiro Nishimura
- Department of Otorhinolaryngology, Aichi Medical University, Aichi, Japan
| | - Hirohiko Kakizaki
- Department of Oculoplastic, Orbital, and Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
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Rajak SN, Psaltis AJ. Anatomical considerations in endoscopic lacrimal surgery. Ann Anat 2019; 224:28-32. [PMID: 30953809 DOI: 10.1016/j.aanat.2019.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/03/2019] [Accepted: 03/11/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To provide a review of the anatomy of the lacrimal drainage system and lateral wall of the nose pertaining to endoscopic dacryocystorhinostomy. METHODS The authors performed a PubMed search of articles published pertaining to the anatomy of the lateral wall of the nose and the anatomy of endonasal and external dacryocystorhinostomy surgery. RESULTS The article covers the regional surface and surgical anatomy for endoscopic dacryocystorhinostomy (DCR), including the maxillary line, middle turbinate, agger nasi air cell, lacrimal sac and fossa and the upper portion of the nasolacrimal drainage system. It also explores the dimensions and location of bony ostium formation to ensure full exposure and marsupialisation of the lacrimal sac. Finally, it covers the anatomy of potential complications of endoscopic DCR surgery including penetration of the skull base and orbit, inadvertent entry to the maxillary sinus and breach of the skin. CONCLUSION A good understanding of the anatomy of the lacrimal drainage system and the lateral wall of the nose will increase the likelihood of successful surgery and minimize the risk of complications and damage to neighbouring structures such as the orbit and skull base.
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Affiliation(s)
- Saul N Rajak
- The Sussex Eye Hospital, Brighton and Sussex University Hospital, United Kingdom; Brighton and Sussex Medical School, United Kingdom
| | - Alkis J Psaltis
- Department of Otolaryngology, Head and Neck Surgery, Queen Elizabeth Hospital, Adelaide, Australia; Faculty of Health Sciences, Department of Otolaryngology Head and Neck Surgery, University of Adelaide, Australia.
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Morphology and morphometry of lacrimal drainage system in relation to bony landmarks in Caucasian adults: a cadaveric study. Int Ophthalmol 2017; 38:2463-2469. [PMID: 29222730 DOI: 10.1007/s10792-017-0753-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/16/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The objective of this study is to examine the morphometry of the lacrimal drainage system with reference to bony landmarks in the vicinity. METHODS Twenty midsaggitalized heads obtained from sixteen preserved cadavers were studied. Measurements involved detailed morphometry of anterior and posterior lacrimal crests, bony lacrimal sac fossa, entrance and length of the bony nasolacrimal duct (NLD), attachment of Horner's muscle, and characteristics of the inferior meatal opening of the NLD. RESULTS The mean lengths of anterior and posterior lacrimal crests were 16.3 and 12.5 mm, respectively. At the midpoint of the posterior lacrimal crest, Horner's muscle was found to be attached at a mean of 1.3 mm posterior to the crest. The mean dimensions of the bony lacrimal sac fossa at superior, mid and inferior levels were 6.5, 8.7, and 5.9 mm, respectively. The mean contribution of the lacrimal bone to the lacrimal sac fossa was 56.2%. The mean anteroposterior and transverse diameters of the entrance of the bony NLD were 5.7 and 4.7 mm, respectively. The most common type of NLD opening in the inferior meatus was that of "vertical sulcus" (70%, 14/20). The mean distance of the NLD opening from the anterior nasal spine and Limen nasi were 22.2 and 18.9 mm, respectively. CONCLUSION This study provides useful anatomical and positional relationship of bony lacrimal landmarks and nasolacrimal duct in Caucasian adults.
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Abstract
PURPOSE To evaluate the clinical usefulness of measuring the lacrimal sac fossa length using orbital computed tomography in normal Koreans. METHODS The authors retrospectively evaluated 140 patients (70 males and 70 females) who underwent orbital computed tomography at Guro Hospital and who had no history of orbital disease or orbital trauma. Computed tomography scans of the right orbit, including the proportion of the lacrimal bone and maxillary bone that comprise the lacrimal sac fossa, were evaluated at 3 different axial planes (lower, middle, and upper levels). Additionally, the mid-point thickness and maximum thickness of the maxillary bone were measured. Finally, the authors also evaluated the relationship between nasal bone height and maxillary bone thickness in the lacrimal sac fossa. RESULTS Maxillary bone thickness in the lacrimal sac fossa was thicker in males than in females at mid-point thickness and maximum thickness (P < 0.05). However, there was no significant difference in the size of the lacrimal sac fossa and the proportion of the maxillary bone between males and females.In comparisons between maxillary cross-sections, bone thickness was greater toward the upper level of the lacrimal sac fossa (P = 0.008), and the proportion of the maxillary bone was also greater (P = 0.006).Aging had a significant positive correlation with maxillary bone thickness at all 3 axial planes (P < 0.05), but there was no relationship between age and maxillary bone proportion. Nasal bone height and maxillary bone thickness were also not significantly related. CONCLUSION In comprising the lacrimal sac fossa, the maxillary bone accounted for a bigger proportion than the lacrimal bone. Male maxillary bone thickness was greater than female thickness. The authors also observed that maxillary bone thickness increased toward the upper areas of the lacrimal sac fossa and with increasing subject age. Understanding the form and variation of a normal lacrimal sac fossa is helpful for preparing for a successful osteotomy with endoscopic dacryocystorhinostomy.
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Minimally invasive medial maxillectomy and the position of nasolacrimal duct: the CT study. Eur Arch Otorhinolaryngol 2016; 274:1515-1519. [PMID: 27844224 PMCID: PMC5309289 DOI: 10.1007/s00405-016-4376-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/04/2016] [Indexed: 10/25/2022]
Abstract
Several minimally invasive modifications of endoscopic medial maxillectomy have been proposed recently, with the least traumatic techniques utilizing the lacrimal recess as a route to enter the sinus. The aim of the study was to analyze the anatomy of medial maxillary wall in the region of nasolacrimal canal and, thus, to determine the capability of performing minimally invasive approach to the maxillary sinus leading through the lacrimal recess. The course of nasolacrimal canal and the distance between the anterior maxillary wall and the nasolacrimal canal (the width of lacrimal recess) were evaluated in 125 randomly selected computed tomography (CT) head examinations. The proportion of cases with unfavorable anatomical conditions (lacrimal recess too narrow to accept a 4 mm optic) to perform minimally invasive middle maxillectomy was assessed. The width of lacrimal recess, measured at the level of the inferior turbinate attachment, varied between 0 and 15.2 mm and was related to slanted course of nasolacrimal canal. The more perpendicular the axis of the canal to the nasal flor, the narrower the lacrimal recess. In about 16% of cases, lacrimal recess width was less than 4 mm and in 14.4% it was missing. The endoscopic approach to maxillary sinus leading through lacrimal recess is possible in about 70% of patients. In the remaining group of patients when the lacrimal recess is too narrow, this type of approach may be difficult to perform without damaging the piriform aperture rim or bony framework of nasolacrimal duct, or it may be impracticable when lacrimal recess is missing.
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Radiological Comparison of the Lacrimal Sac Fossa Anatomy Between Black Africans and Caucasians. Ophthalmic Plast Reconstr Surg 2016; 31:328-31. [PMID: 26039331 DOI: 10.1097/iop.0000000000000457] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare, in black Africans and Caucasians, the radiological anatomy of the intranasal structures and lacrimal sac fossa as relevant to dacryocystorhinostomy. METHODS 0.75 mm section cranio-orbital computed tomography scans from 72 patients (42 black Africans and 30 Caucasian) were included in this retrospective observational case series. Only one orbit from each scan was utilized. The main outcome measures were: the thickness and proportions of the lacrimal bone and frontal process of the maxilla evaluated at 3 axial planes (upper, middle, lower) in the lacrimal sac fossa; 2 measurements of maxillary thickness were obtained at each plane-namely, the "midpoint thickness" and the "maximum thickness." The anterior extent of the nasal mucosa was also evaluated. RESULTS The frontal process of the maxilla was thickest inferiorly (p < 0.001) and the maximum maxillary thickness was significantly thicker in black Africans as compared with Caucasians (p < 0.001) at all planes. At midfossa level, the proportion of maxillary bone forming the lacrimal fossa wall was significantly greater in black Africans (p < 0.01). In contrast, the length of nasal mucosa available for creation of an anastomosis, as estimated from the greatest mucosal height, was significantly greater in Caucasians (p < 0.01). CONCLUSIONS Black Africans have a lacrimal sac fossa bounded by thicker maxillary bone, this bone constituting a higher proportion of the fossa wall at its midpoint, and also have significantly less nasal mucosa available for soft-tissue anastomosis during lacrimal drainage surgery. The anterior lacrimal crest, comprising the frontal process of the maxilla, was thickest at the lowest plane in both black Africans and Caucasians.
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Anatomical landmarks of the lateral nasal wall: implications for endonasal lacrimal surgery. Curr Opin Ophthalmol 2015; 26:408-15. [PMID: 26107928 DOI: 10.1097/icu.0000000000000160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW An accurate understanding of the anatomy of the lateral nasal wall is key to achieving complete exposure of the lacrimal sac during endonasal dacryocystorhinostomy (EnDCR) and the avoidance of complications such as basal skull fracture and orbital fat prolapse. This review provides a comprehensive summary of the clinical and cadaveric anatomical studies of the lateral nasal wall to date and their application to endonasal lacrimal surgery. RECENT FINDINGS The maxillary line and the axilla of the middle turbinate are the major landmarks commonly utilized by lacrimal surgeons to localize the lacrimal sac. Numerous clinical, cadaveric and radiologic studies have attempted to define the relationship of these and other important anatomical landmarks, closely related to the lacrimal sac and routinely encountered during endonasal surgery, such as the frontal process of the maxilla, the agger nasi air cell and the uncinate process. A greater understanding of the relevant endonasal anatomy over time has led to safer and more effective surgical techniques. SUMMARY Greater insights into the precise anatomical relationship of the lacrimal sac to other structures on the lateral nasal wall has enabled lacrimal surgeons to perform EnDCR surgery in a more accurate, efficient and well tolerated manner, matching its success to that of the external approach.
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Raikos A, Waidyasekara P, Morrison AK. Surgical and topographic anatomy of the maxillary line: an important landmark for endoscopic nasal surgery. Ann Anat 2014; 197:24-8. [PMID: 25466929 DOI: 10.1016/j.aanat.2014.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/21/2014] [Accepted: 10/21/2014] [Indexed: 11/16/2022]
Abstract
The maxillary line is an important surgical landmark in the lateral nasal cavity. We investigated its location, variation, and relation to other landmarks in 47 formalin fixed cadaveric half-heads dissected in steps. Measurements and observations were made to describe the topography of the maxillary line, maxillary line midpoint (M-point), and their relationship with surgically important structures. The mean curved length of the maxillary line was 15 mm (SD 3.5) and can be classified into three types. The M-point had a mean vertical distance of 0.8mm (SD 2.9) below the nasolacrimal sac-duct junction. It was found below, above, or on the same level as the nasolacrimal sac-duct junction in 57.4%, 38.3%, and 4.3% of specimens, respectively. In 51.1% the M-point was anterior to the nasolacrimal duct axis and 48.9% overlapping the lacrimal apparatus. The maxillary line and its M-point are useful surgical landmarks for localizing the nasolacrimal duct segments.
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Affiliation(s)
- Athanasios Raikos
- Anatomical Sciences, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD, Australia.
| | - Pasan Waidyasekara
- Anatomical Sciences, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD, Australia; Gold Coast University Hospital, Gold Coast, QLD, Australia.
| | - Amy Kathleen Morrison
- Anatomical Sciences, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD, Australia; Gold Coast University Hospital, Gold Coast, QLD, Australia.
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