Anterior maxillary wall and lacrimal duct relationship in Orientals: CT analysis for prelacrimal access to the maxillary sinus.

Abstract

The pre-lacrimal window approach (PLWA) is a promising technique in approaching lesions of the anterior wall and floor of the maxillary sinus. Simmen et al. previously reported that this approach is feasible in only 2/3 of their patients. This percentage appears to be lower than that of our local (mainly Chinese) population based on our clinical experience. Our study aims to measure the distance between the anterior maxillary wall and lacrimal duct in ethnic Chinese. A higher incidence of sphenoid-ethmoidal cells has been reported in Orientals. We postulate that there is also a higher incidence of wider pre-lacrimal recesses in Orientals thus making the PLWA more feasible to perform in Orientals. 100 consecutive sinus CT scans of adult patients with various rhinologic diseases that did not distort the bony anatomy of the maxilla were reviewed (2 sides each). The distance between the anterior maxillary wall and the anterior border of the lacrimal duct was measured in 200 sides. We have adopted the methodology of measurements previously published by Simmen et al. This is so that we could compare between Oriental and Occidental paranasal sinuses. A distance of more than 7mm was found in 39.5% of our subjects and a distance of > 3-7mm was seen in 53.5%. In 6.5% of our subjects we found a prelacrimal recess < 3mm. The PLWA could have been performed without removal of the bony lacrimal canal in 39.5% of our subjects ( > 7mm). Good access to the anterior maxilla wall could also have been possible for 53.5% with sub-periosteal removal of the bony lacrimal canal and medial maxillary wall. Thus, the PLWA would have been feasible for 93% of our subjects. These percentages are significantly higher than Simmen's study of 68.5% in an Occidental population.