Anatomy of lacrimal sac fossa affecting success rate in endoscopic and external dacryocystorhinostomy surgery
- VernacularTitle:Нулимсны хүүдийн хонхрын анатомийн бүтэц уламжлалт болон дурангийн дакриоцисториностоми мэс заслын үр дүнд нөлөөлөх нь
- Author:
Bayasgalan Purevdorj
1
;
Uranchimeg Dugarsuren
1
;
Bulgan Tuvaan
1
;
Baasankhuu Jamiyanjav
1
Author Information
1. Mongolian National University of Medical Sciences
- Publication Type:Journal Article
- Keywords:
Agger nasi cell;
endoscopic dacryocystorhinostomy;
lacrimal sac fossa;
middle turbinate;
nasolacrimal duct obstruction;
uncinate process
- From:Mongolian Medical Sciences
2021;196(2):8-12
- CountryMongolia
- Language:Mongolian
-
Abstract:
Introduction:Primary acquired nasolacrimal duct obstruction (PANDO) is a common cause of epiphora in adults,
standard surgery for blockage of the lacrimal outflow tract is the dacryocystorhinostomy (DCR). The
majority of studies have analyzed the lacrimal system of whites anatomically and presented guidelines
for endonasal DCR. It has been our experience that DCR procedures for Asians are more difficult
than for whites and we reasoned that the difficulty might be attributable to the anatomic differences in
the intranasal structures between the races. Before we started doing endoscopic endonasal DCR in
Mongolia, there was no hospital doing this surgery and there was lack of study done on anatomy of
lacrimal fossa and DCR surgery result among Mongolians are our rationale of study.
Goal:To study the effect of anatomical variance of lacrimal sac fossa on dacryocystorhinostomies performed
by the endoscopic endonasal approach.
Material and Methods:A total of 292 consecutive cases of DCR were performed age between 16-75 years old who have
primary nasolacrimal obstruction (ICD-H04.559). This study was approved by the Ethics Committee of
Mongolian National University of Medical Sciences. A total of 146 EX-DCR and 146 EN-DCR patients
were identified. Full success was defined as no symptoms of tearing after surgery and anatomical
patency with lacrimal irrigation. Standard Lac-Q questionnaire was used to compare satisfaction of
the surgery in both groups. All statistical tests were two-sided, and a p-value of <0.05 was considered
to be statistically significant. Statistical analysis was performed using STATA for Windows version
11.2.
Results:There was no significant difference in age or gender distribution between the two groups. Frontal
process of the maxillary bone is 4.41± 1.96 mm in successful group and 4.97± 1.04 in failed group
(p<0.05). The uncinate process was attached to the lacrimal sac fossa in 80.1% of the all cases and
100% in surgery failed group (p<0.05). The variation that agger nasi cell adjacent to the lacrimal sac
fossa was in 93.9%. The operculum of the middle turbinate was attached to the lacrimal sac fossa in
94.5% of the cases (p=0.76). Postoperative assessment was performed for 6 months. Patients who
underwent endonasal group reported a 11.0-point improvement (IQR, 9.0–16.5).
Conclusions:A thick frontal process of the maxilla and uncinate process, operculum of the middle turbinate, and
ethmoid cells adjusting to lacrimal fossa are dominant in Mongolians. Patients who have these
features are prone to have recurrence of nasolacrimal duct obstruction after DCR surgery. The EN-DCR have a high surgical success rate and good result on reduce of symptoms and improvement in
quality of life by using the Lac-Q standard questionnaire.
- Full text:2021-196(2)-8-12.pdf
