Abstract
SummaryDacryocystorhinostomy is the treatment of choice for the obstruction of the lachrymal apparatus. At the end of last century, the development of the endoscopic instruments for nasosinusal surgery has made it possible to do it through the endoscopic pathway. Nonetheless, anatomical variations make it difficult to have reproducibility endonasaly.Aimstudy the endoscopic anatomy of the lachrymal fossa through transillumination of the common canaliculus.Study designexperimental.Materials and Methodswe dissected 40 lachrymal pathways from 20 human cadavers, in three stages: 1. identification and dilation of the lachrymal canaliculus. 2 -Optic fiber beam introduction; 3 - endoscopic dissection of the lachrymal sac, describing its position.Resultsthe most frequent position of the lachrymal sac was between the free border of the middle turbinate and its insertion immediately underneath it. The maxillary line was seen in 95% of the cases. Septoplasty was needed in 12.5%, unicifectomy in 35% and middle turbinectomy in 7.5%.ConclusionAlthough the lachrymal sac has a more frequent location, its position varied considerably. The transillumination of the common canaliculus proved useful, solving the problem of the anatomical variability.
Highlights
The nasolachrymal duct stenosis causes constant tearing, recurrent dacryocystitis and mucocele formation
Dacryocystorhinostomy (DCR) is the surgical procedure of choice for the treatment of these conditions and it is based on creating a permanent communication canal between the lachrymal apparatus structures and the nasal cavity by means of a bony window opened through a nasal wall resection at the lachrymal fossa located on the lateral wall of the nasal cavity
The present paper aims at using common canaliculus transillumination in order to study the surgical anatomy of the lachrymal fossa of the lateral nasal wall using the endoscope, analyzing its relation with the anatomical reference points of the nasal cavity, especially middle meatus and nasal septum structures, contributing to a standardization of the procedures during endoscopic dacryocystorhinostomy (DCR-en)
Summary
The nasolachrymal duct stenosis causes constant tearing (epiphora), recurrent dacryocystitis and mucocele formation. Dacryocystorhinostomy (DCR) is the surgical procedure of choice for the treatment of these conditions and it is based on creating a permanent communication canal between the lachrymal apparatus structures and the nasal cavity by means of a bony window (rhinostomy) opened through a nasal wall resection at the lachrymal fossa located on the lateral wall of the nasal cavity. The external approach was described by Toti[1] and, with some modifications it was the standard procedure for the treatment of obstructed lachrymal pathway, always done by ophthalmologists. Before Toti, Caldwel[2] had described the endonasal approach, advocating the bony resection on the lateral nasal wall through the inferior portion of the middle meatus. There are significant anatomical variations in the middle meatus regarding its conventional reference points (middle concha, uncinate process, ethmoidal bulla) and of these with the lachrymal pathway, making it difficult to have a reproducible technique to approach the lachrymal pathway through the lateral nasal wall based solely on anatomical parameters
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