Intranasal Approach Research Articles

Photobiomodulation Therapy on Brain: Pioneering an Innovative Approach to Revolutionize Cognitive Dynamics.

Photobiomodulation (PBM) therapy on the brain employs red to near-infrared (NIR) light to treat various neurological and psychological disorders. The mechanism involves the activation of cytochrome c oxidase in the mitochondrial respiratory chain, thereby enhancing ATP synthesis. Additionally, light absorption by ion channels triggers the release of calcium ions, instigating the activation of transcription factors and subsequent gene expression. This cascade of events not only augments neuronal metabolic capacity but also orchestrates anti-oxidant, anti-inflammatory, and anti-apoptotic responses, fostering neurogenesis and synaptogenesis. It shows promise for treating conditions like dementia, stroke, brain trauma, Parkinson's disease, and depression, even enhancing cognitive functions in healthy individuals and eliciting growing interest within the medical community. However, delivering sufficient light to the brain through transcranial approaches poses a significant challenge due to its limited penetration into tissue, prompting an exploration of alternative delivery methods such as intracranial and intranasal approaches. This comprehensive review aims to explore the mechanisms through which PBM exerts its effects on the brain and provide a summary of notable preclinical investigations and clinical trials conducted on various brain disorders, highlighting PBM's potential as a therapeutic modality capable of effectively impeding disease progression within the organism-a task often elusive with conventional pharmacological interventions.

Application of Dural Suturing in Reconstruction of Sellar Floor for Cerebrospinal Fluid Leakage During Neuroendoscopic Intranasal Approach Surgery: A Meta-Analysis.

To assess the safety and efficacy of utilizing dural suturing as an adjunctive procedure for saddle floor reconstruction in patients undergoing endoscopic surgery in the sellar region. According to the PRISMA guidelines, we searched the literature on sellar floor reconstruction in endoscopic sellar surgery. Fixed- or random-effects meta-analysis was used to pool the rate of return to postoperative cerebrospinal fluid (poCSF) leakage, repair operations, postoperative hospitalization, complete resection, infection, lumbar drainage (LD), and operative duration. A total of six studies involving 723 participants were included in the current meta-analysis. The pooled results demonstrated that patients in the dural suturing group had a lower incidence of poCSF leakage [odds ratio (OR), 0.18; 95% confidence interval (CI), 0.07 - 0.44; p=0.0002] and repair operation [OR, 0.24; 95% CI, 0.07 - 0.78; p=0.02], as well as a shorter hospitalization period [standardized mean difference (SMD), -0.45; 95% CI, -0.62 - -0.28; p < 0.00001]. There was no significant difference between the two groups in terms of the complete resection [OR, 1.06; 95% CI, 0.62 - 1.80; p=0.84], postoperative infection [OR, 0.49; 95% CI, 0.21 - 1.15; p=0.10] and lumbar drainage (LD) [OR, 0.28; 95% CI, 0.06 - 1.23; p=0.09]. Additionally, the dural suturing group may require a longer operative duration [SMD, 0.29; 95% CI, 0.02 - 0.56; p=0.03]. The results suggest that dural suturing can be advantageous in reducing postoperative complications and shortening postoperative hospitalization following neuroendoscopic surgery in the sellar region without increasing the risk of infection.

Evaluating the efficiency of endoscope-assisted septo-rhinoplasty via intranasal approach

Objective: To observe the functional and esthetic results of endoscope-assisted septo-rhinoplasty via intranasal approach. Methods: The clinical data of 12 patients with septal deviation and nasal deformity in the University of Hong Kong-Shenzhen Hospital from June 2021 to June 2022 were analyzed, including 8 males and 4 females, aging 28 to 58 years. All patients were operated under general anesthesia. The septal deviation was corrected by hemitransfixion incision, combined with intercartilaginous incision and other intranasal or extranasal incisions to perform osteotomy, hump resection and saddle nose correction. Patient satisfaction with postoperative functional and aesthetic improvements was assessed through Nasal Obstruction Symptom Evaluation (NOSE), Rhinoplasty Outcome Evaluation (ROE), and Visual Analogue Scale (VAS).SPSS 25 software was used for statistical analysis. Results: The correction of nasal septum deviation was satisfactory in all 12 patients. Nasal obstruction was relieved, with NOSE score and VAS score of nasal ventilation decreased [(21.67±10.30) vs (70.83±14.12), (1.83±1.03) vs (8.33±0.89), t value was 9.49 and 16.30, respectively, both P<0.05]. The nasal appearance of 10 patients with crooked nose deformity was improved, with ROE score and VAS score of nasal appearance increased [(21.30±2.31) vs (8.10±3.31), (8.90±0.99) vs (3.80±1.62), t value was -11.85 and -9.33, respectively, both P<0.05];The nasal vestibule morphology of 2 patients with abnormal nasal vestibule was improved. During the follow-up of 12 to 24 months, no postoperative complication such as nasal septum perforation, nasal cavity adhesion or nasal dorsal collapse occurred in all patients. Conclusion: Endoscope-assisted septo-rhinoplasty via intranasal approach can resolve both functional and esthetic problems at the same time, improving outcomes while reducing surgical trauma.

A review on sinoscopy in the horse: Traditional and minimally invasive techniques and sinoscopic treatment of paranasal disease

SummarySinoscopy consists of direct visualisation of the paranasal sinuses and was first conceived for diagnostic purposes using a rigid endoscope through a skull trephination. Since then, the use and approaches to perform it have evolved thanks to current advancements in knowledge (sinus anatomy and pathology) and technology. The aim of this article is to review the techniques reported to perform traditional and minimally invasive sinoscopy and to review the current use of sinoscopy to treat paranasal sinus disease. The history of sinoscopy, as we know it today, is relatively recent, but its use among clinicians is not necessarily widespread despite the invasiveness of the traditional technique when compared to imaging techniques. This limitation could be bypassed using the newer intranasal or extranasal minimally invasive sinoscopic approaches. These techniques allowed sinoscopic visualisation through natural orifices or minimally invasively created openings. Despite the potential of these techniques, case selection is still crucial as visualisation can be limited in selected disorders (i.e. sinus cyst), some sinuses (i.e. rostral maxillary with intranasal approaches) and if haemorrhage or severe exudate accumulation is found. Nevertheless, sinoscopy offers a diagnostic rate superior to traditional imaging and it is an alternative diagnostic tool when advanced imaging techniques, such as CT, are not available. In recent years, sinoscopic treatment has been progressively replacing the use of sinusotomies to treat most sinus disorders. Sinoscopic treatment yields a high‐resolution rate while complications are kept low. Familiarisation with sinoscopic techniques and in‐depth anatomic sinus knowledge will likely make sinoscopy the gold standard technique to treat sinus disease in the near future.

Carotenoid containing cationic nanoparticles for effective therapy for suppressing oxidative stress: An intranasal approach

Alzheimer's disease is the most common type of dementia. Oxidative stress is involved in the progression of aging and Alzheimer's disease. It is known that lutein is a carotenoid having antioxidant properties. The present research explores Lutein loaded chitosan nanoparticles for Suppressing Oxidative Stress in the treatment of Alzheimer's. The developed nanoparticles are administered through the nose to target brain via nose-to-brain pathway. For optimization of formulation a systematic QbD approach was used. The developed nanoparticles further characterized for Physicochemical parameters, Morphology, In-vitro drug releases, Ex-vivo diffusion, In-vitro Cell viability, cellular uptake, In-vitro BBB Permeation, antioxidant properties, In-vivo biodistribution, and stability study. The developed nanoparticles' surface morphology suggested homogeneously dispersed spherical nanoparticles having < 200 nm size. The drug release study demonstrate the controlled release of lutein for more than 96 h while less than 50% lutein was released after 24 h in an ex-vivo diffusion study. The cell cytotoxicity assay confirms the nontoxicity of l-CNPs. The cellular uptake study shows enhanced internalization of l-CNPs through the caveolae-mediated endocytosis pathway. The ROS generation confirmed the absence of any significant ROS generation nanoparticles. The antioxidant assay shows significant ROS scavenging activity of l-CNPs. In-vitro BBB permeation demonstrates the efficient passage of l-CNPs through BBB compared to pure lutein. This was further supported by bio-distribution demonstrating the deposition of nanoparticles in the brain through nasal administration. The acquired outcomes prove the possible activities of lutein-loaded l-CNPs for reducing oxidative stress in the brain for Alzheimer's treatment.

Extraction of high inverted mesiodentes via the labial, palatal and subperiostal intranasal approach：A clinical prospective study

The aim of this study is to provide criteria for the choice of the surgical approach for extraction of high inverted mesiodens.The operation statistics, life quality of postoperative patients, and the operative injury/recovery were compared and analysed. The laser Doppler blood flowmetry, laser speckle contrast imaging, and electric pulp testing were explored to detect the postoperative pulp and gingiva blood supply of adjacent teeth.For the clinician's primary concerns, the surgical time, the volume of osteotomy, and the amount of bleeding in the labial approach group (The p values are 0.0001, <0.0001, and 0.0131, respectively.) and intranasal approach group (All p values were <0.0001.) were significantly less than that in the palatal approach group. However, from the patient's perspective, the postoperative swelling in the labial approach was far more than that in the intranasal approach group (p =0.0044), with unsurprisingly lower satisfaction (p <0.0001). There were no significant differences in pulp and gingival blood supply of adjacent teeth and jaw development. Trauma was manageable in all patients.Within the limitations of the study it seems that extraction of mesiodens by the intranasal approach achieves a delicate balance between reducing surgical trauma and optimizing postoperative recovery.

A Double Intranasal Approach to Treat Cholesteatoma of the Maxillary Sinus: A Report of Two Cases and a Literature Review

A Double Intranasal Approach to Treat Cholesteatoma of the Maxillary Sinus: A Report of Two Cases and a Literature Review

A Study on Morphometry and Related Surgical Importance of Naso Lacrimal Duct

Introduction: The Nasolacrimal duct is the terminal part of the nasolacrimal apparatus or tear apparatus. The anatomy of lateral nasal wall is Important for planning the surgeries on lacrimal duct through intranasal approach. Objective: The current study was designed to review the anatomy of nasolacrimal duct in relation to the lateral nasal wall. Material and method: Thirty sagittal sections (14 right and 16 left side) of head and neck of formalin fixed adult cadavers of known sex, gender, ethnicity present in department of anatomy GMCH, Chandigarh were studied. The following parameters were made using a digital calliper and rounded off to the nearest millimetres. 1.Length of nasolacrimal duct (NLD Length) 2. Nearest distance from the nasolacrimal duct to maxillary sinus ostium (NLD - MSO) 3. Nearest distance from the NLD to the anterior nasal spine. (NLD- ANS)4. Nearest distance of the intranasal orifice of the NLD to the nasal floor (NLD- NF) 5. Nearest distance of the intranasal orifice of the NLD to the nasal roof. (NSD- NR) 6. Nearest distance of the intranasal orifice of the NLD to the anterior attachment of the Inferior concha. (NSD- AIT). Observations: In our study the average length of the NLD was 19.8±1.57mm. The intranasal orifice of the NLD was observed to be located on an average of 24.5±2.6mm from the anterior nasal spine, ranging from 5.5-2. 9mm.The average distance from the nasal roof was found to be 32.2±1.67mm and 16.08±1.71mm from nasal floor. In addition, the average distance from the anterior attachment of inferior nasal concha was found to be 14.82±2.37mm. In our study the NLD was an average of 4.08±0.67mm anterior to MSO at the level of the anterior attachment of the MT. On Comparing right and left side The NLD Was found to be slightly longer 22.7 in comparison of 22.2 mm on left side. The distance of NLD From MSO was also found to be larger on left side. The distances of NLD-ANS, NLD NR, NLD -AIT and NLD- NF were also longer on left side. Conclusion: We found that most of the parameters were closer to a study done by Ertugel while the NLD-NF distance was more in our specimen. Running title: nasolacrimal duct: morphometry, surgical importance KEY WORDS: Nasolacrimal duct, Maxillary sinus ostium, nasal floor, nasal roof, Anterior attachment of inferior concha.

Comparative evaluation of extrasinus versus intrasinus approach for zygomatic implant placement.

Edentulism, a common problem can occur either as a congenital defect or acquired later due to dental caries, periodontitis, as a consequence of aging, maxillofacial trauma or post-ablation in tumor resections. The rehabilitation of the missing teeth can be done using dental implants. To overcome the deficiency of available bone, processes like sinus augmentation with substituted bone graft and Le Fort I osteotomy with interpositional bone graft have been described in the literature. In order to overcome the associated limitations with these procedures, implants were designed that can be placed in specific anatomical areas like zygoma. This study aims to compare two different types of surgical approaches (Intrasinus vs Extrasinus) for the placement of zygomatic implants to treat atrophic maxilla. The placement of zygomatic implant through both extrasinus and intrasinus approaches were evaluated on the basis of different parameters and it was observed that postoperative pain and swelling was significantly found in intra sinus approach as compared to extra sinus approach. However, in the intranasal approach, poor patient compliance or low satisfaction rate was observed as compared to extra sinus approach. On the basis of the results of the study and post operative evaluation based on various criteria, it was concluded that extra sinus approach has got an edge over intra sinus approach.

Th1 and Th17 mucosal immune responses elicited by nasally inoculation in mice with virulence factors of Mycoplasma hyopneumoniae

Nicotinamide Adenine Dinucleotide-Dependent (NADH) flavin oxidoreductase and NADH oxidase (NOX) are important virulence factors of Mycoplasma hyopneumoniae (Mhp), which are devoted to the function of adhesion, oxidative stress damage and apoptosis to host cells in our previous studies. Here, immune responses of NADH flavin oxidoreductase (NFOR) and NOX in mice and immune efficacy inoculated with intramuscular (IM), intranasal (IN), intramuscular unite intranasal (IM + IN) approaches were evaluated and compared. Cellular immunity levels, systemic immune and local mucosal immune responses were investigated by indirect enzyme-linked immunosorbent assay (iELISA) and quantitative reverse transcription PCR (qRT-PCR). Mice inoculated with NFOR and NOX by IM and IN or IM + IN could induce obvious secretion of specific immunoglobulin G (IgG) and secretory immunoglobulin A antibodies (sIgA) compared to those in negative control group. IM + IN inoculation resulted in systemic and local mucosal immune responses that were strongly produced. Moreover, Mhp NFOR and NOX could activate local mucosal immune responses mediated by Th1 and Th17 cells by IN. Our finding supported the notion that IM + IN was an effective immunization route for Mhp, which lays a foundation for more effective prevention of Mhp, and provides theoretical basis for the development of new subunit vaccines of Mhp.

Paranasal Augmentation: A Viable and Simplified Modality With Diced Expanded Polytetrafluoroethylene.

A flat or concave lower midface profile is generally considered less attractive. Paranasal augmentation is usually performed to move paranasal deficiency to relative convexity. Herein, we present a viable and simplified modality with diced expanded polytetrafluoroethylene to correct paranasal deficiency. Between February of 2020 and April of 2021, 19 patients underwent procedures to correct paranasal deficiency. Paranasal augmentation was performed with diced expanded polytetrafluoroethylene. All procedures were performed via intranasal approach. Preoperative and postoperative photographs were taken. Of these 19 patients (18 women and 1 man), deficiency of 18 patients were caused by congenital factors and 1 by cleft deformities. All but 1 procedures were carried out bilaterally. Procedures were performed in conjunction with additional operations mainly including rhinoplasty and minimally invasive midface lift. Age of patients ranged from 19 to 57 years, with a mean of 37 years. Follow-up time ranged from 8 to 22 months, with a mean of 12.6 months. All patients were satisfied with esthetic improvement and facial holistic profile. No severe complications and reoperation arisen in any of the patients. Temporary discomfort involved foreign body sensation in 1 case and numbness in 2 cases. The present technique provides a viable and simplified method to give the face a more balanced appearance and achieves esthetically superior results.

A Case of Angioleiomyoma in Nasolacrimal Duct

Epiphora is a symptom in which tears overflow onto the face, with its most common cause being the obstruction of the nasolacrimal system. As a cause of nasolacrimal system obstruction, nasolacrimal duct tumors are very rare. Angioleiomyoma, which is a benign tumor, arises from vascular smooth muscle, occurs in the nasolacrimal duct, and is extremely rare. With the development of endoscopic intranasal approach for the treatment of nasolacrimal duct obstruction, there is increased importance for the consideration of otorhinolaryngological evaluation and treatment as well as dacryocystorhinostomy by conventional external approach. In this article, we introduce a case in which angioleiomyoma in the nasolacrimal duct was detected by nasal endoscopy and was successfully treated with endoscopic surgery.

Getting Into the Brain: The Intranasal Approach to Enhance the Delivery of Nerve Growth Factor and Its Painless Derivative in Alzheimer's Disease and Down Syndrome.

The neurotrophin Nerve Growth Factor (NGF) holds a great potential as a therapeutic candidate for the treatment of neurological diseases. However, its safe and effective delivery to the brain is limited by the fact that NGF needs to be selectively targeted to the brain, to avoid severe side effects such as pain and to bypass the blood brain barrier. In this perspective, we will summarize the different approaches that have been used, or are currently applied, to deliver NGF to the brain, during preclinical and clinical trials to develop NGF as a therapeutic drug for Alzheimer’s disease. We will focus on the intranasal delivery of NGF, an approach that is used to deliver proteins to the brain in a non-invasive, safe, and effective manner minimizing systemic exposure. We will also describe the main experimental facts related to the effective intranasal delivery of a mutant form of NGF [painless NGF, human nerve growth factor painless (hNGFp)] in mouse models of Alzheimer’s disease and compare it to other ways to deliver NGF to the brain. We will also report new data on the application of intranasal delivery of hNGFp in Down Syndrome mouse model. These new data extend the therapeutic potential of hNGFp for the treatment of the dementia that is progressively associated to Down Syndrome. In conclusion, we will show how this approach can be a promising strategy and a potential solution for other unmet medical needs of safely and effectively delivering this neuroprotective neurotrophin to the brain.

Closed Piezo Preservation Rhinoplasty.

The application of piezoelectric instruments (PEIs), which made the work with the nasal pyramid a predictable and controlled stage of rhinoplasty, is still more often related to the open approach. The intranasal approach is constantly associated with standard methods of osteotomies, including percutaneous techniques, which represent certain limitations in working with the bony vault without managing the surface and thickness of its walls and the risk of uncontrolled fractures. The authors apply PEIs for osteotomies and reshaping of the nasal pyramid through the closed approach with preservation rhinoplasty and complete subperichondrial and subperiosteal dissection. The technique of working with the nasal pyramid using PEIs with the closed approach is described. The patients were grouped according to the methods of nasal pyramid surgery-Push Down (PD), Let Down (LD) with Rhinosculpture (Rs), or the combinations. The results of the surgeries with the application of PEIs on 134 patients were retrospectively analyzed before the surgery and 12 months after it according to the "Rhinoplasty Outcome Evaluation" (ROE). The average age of the patients was 28, 125 were female and 9 were male. The patients' satisfaction was excellent in 96% of all the cases included. There were two cases with residual humps and four cases with residual asymmetries in cases of severe deviations. Via intranasal approach, it is possible to use PEIs for managing the bony vault in primary rhinoplasty. The limitations for this technique are underdevelopment of the nasal dorsum, cleft lip nose situations, post-traumatic and previous rhinoplasty cases. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Diagnostic and treatment challenges in neurofibroma concerning the external nose.

This paper discusses clinical features and management aspects of an extremely rare entity, neurofibroma of the external nose. Database searches were performed using PubMed, Embase and Google Scholar to identify previously published articles. Twelve articles comprising 13 patients with neurofibroma of the external nose were included. The mean age of presentation was 31 years. Sixty-nine per cent of patients were diagnosed at final histopathology. External approach rhinoplasty was performed in 76.9 per cent of patients, while the intranasal approach was used in 15.3 per cent of patients. There was a 15.3 per cent association with neurofibromatosis type 1. Recurrence was noted in 23 per cent of patients. It may be challenging to diagnose this entity clinically because of its rarity and striking features on histopathology. Neurofibroma of the external nose should be kept in mind as a differential diagnosis for any soft progressive swelling over the nose. Management requires complete excision, with cosmesis and restoration of functions.

Republication de : Letter on the article: “Removal of solitary neurofibroma of the external nose by intranasal approach”

Republication de : Letter on the article: “Removal of solitary neurofibroma of the external nose by intranasal approach”

Intranasal insulin improves mitochondrial function and attenuates motor deficits in a rat 6‐OHDA model of Parkinson's disease

AimsExperimental and clinical evidences demonstrate that common dysregulated pathways are involved in Parkinson’s disease (PD) and type 2 diabetes. Recently, insulin treatment through intranasal (IN) approach has gained attention in PD, although the underlying mechanism of its potential therapeutic effects is still unclear. In this study, we investigated the effects of insulin treatment in a rat model of PD with emphasis on mitochondrial function indices in striatum.MethodsRats were treated with a daily low dose (4IU/day) of IN insulin, starting 72 h after 6‐OHDA‐induced lesion and continued for 14 days. Motor performance, dopaminergic cell survival, mitochondrial dehydrogenases activity, mitochondrial swelling, mitochondria permeability transition pore (mPTP), mitochondrial membrane potential (Δψm), reactive oxygen species (ROS) formation, and glutathione (GSH) content in mitochondria, mitochondrial adenosine triphosphate (ATP), and the gene expression of PGC‐1α, TFAM, Drp‐1, GFAP, and Iba‐1 were assessed.ResultsIntranasal insulin significantly reduces 6‐OHDA‐induced motor dysfunction and dopaminergic cell death. In parallel, it improves mitochondrial function indices and modulates mitochondria biogenesis and fission as well as activation of astrocytes and microglia.ConclusionConsidering the prominent role of mitochondrial dysfunction in PD pathology, IN insulin as a disease‐modifying therapy for PD should be considered for extensive research.

Phase I trial of intranasal NEO100, highly purified perillyl alcohol, in adult patients with recurrent glioblastoma.

BackgroundBetter treatments for glioblastoma (GBM) patients, in particular in the recurrent setting, are urgently needed. Clinical trials performed in Brazil indicated that intranasal delivery of perillyl alcohol (POH) might be effective in this patient group. NEO100, a highly purified version of POH, was current good manufacturing practice (cGMP) manufactured to evaluate the safety and efficacy of this novel approach in a Phase I/IIa clinical trial in the United States.MethodsA total of 12 patients with recurrent GBM were enrolled into Phase I of this trial. NEO100 was administered by intranasal delivery using a nebulizer and nasal mask. Dosing was 4 times a day, every day. Four cohorts of 3 patients received the following dosages: 96 mg/dose (384 mg/day), 144 mg/dose (576 mg/day), 192 mg/dose (768 mg/day), and 288 mg/dose (1152 mg/day). Completion of 28 days of treatment was recorded as 1 cycle. Adverse events were documented, and radiographic response via Response Assessment in Neuro-Oncology (RANO) criteria was evaluated every 2 months. Progression-free and overall survival were determined after 6 and 12 months, respectively (progression-free survival-6 [PFS-6], overall survival-12 [OS-12]).ResultsIntranasal NEO100 was well tolerated at all dose levels and no severe adverse events were reported. PFS-6 was 33%, OS-12 was 55%, and median OS was 15 months. Four patients (33%), all of them with isocitrate dehydrogenase 1 (IDH1)-mutant tumors, survived >24 months.ConclusionIntranasal glioma therapy with NEO100 was well tolerated. It correlated with improved survival when compared to historical controls, pointing to the possibility that this novel intranasal approach could become useful for the treatment of recurrent GBM.

A Comparative study of external dacryocystorhinostomy versus endonasal Dacryocystorhinostomy

Background: Surgical treatment of dacryocystitis dates back to nearly 2000 years ago described as creating an artificial passageway into the nose using hot cautery to puncture through the lacrimal bone. Better understanding of lacrimal physiology and nasal and lacrimal anatomy through the centuries led to development of a procedure that would resemble a modern external DCR surgery in the 18th century. Intranasal approach operations had also been described in the 20th century. Advancements in methods of DCR surgery have been procured in view of cosmesis, amount of bleeding, duration of surgery, and outcome of the procedure.Aim/Objective: The aim of this study is to compare endonasal DCR and external DCR in the following prospect Methods: This was a hospital based, interventional, prospective, non-randomized study of a total of 100 randomly selected patients of chronic dacryocystitis from OPD. 50 patients underwent external DCR and 50 patients underwent endonasal DCR. Young patients with good nasal space and without any nasal abnormality were operated for endonasal DCR, and old patients or those with nasal abnormalities were operated for external DCR. Preoperative assessment included an ENT evaluation, blood pressure, sac syringing, and blood investigations. Surgery was performed and post-operative assessments were conducted in the aspects of complications of surgery, intraoperative bleeding, surgical time and outcome of surgery.Results: From a total of 100 patients, 59% were females of which 54% were operated by endonasal DCR, with 30% of the population of total persons operated aging 60-70 years. There is more prevalence of dacryocystitis in females and in old aged patients in this study due to more chances of lacrimal pump failure in old age, and hormonal factors, smaller skull size and application on local cosmesis for females. Punctum patency after 6 months comparing endonasal and external DCR surgery using chi square formula proved a P value of 0.0008 which is highly significant showing that external DCR has significantly higher success rate than endonasal DCR. In the aspect of complications, the study proved a greater chance of recurrence of epiphora in external DCR, also the presence of a skin scar and wound dehiscence persists as a complication in external DCR due to the external skin incision which is not made in endonasal DCR.Conclusion: DCR is the treatment of choice for nasolacrimal duct obstruction, and it can be performed by external or endoscopic approach. Both approaches have minimal complications and comparable surgical outcome, hence the choice of surgery should depend upon the patient’s preference, availability of resources and surgeon’s expertise.

Prevalence of the prelacrimal recess in maxillary sinus and its medial bony wall dimensions.

To investigate the occurrence rate of the prelacrimal recess (PLR) and its medial bony wall dimensions based on the radiological analysis to help surgeons enhance the understanding of anatomic structures for the endoscopic prelacrimal recess approach. Cone-beam computed tomography images of 255 patients were evaluated retrospectively. The prevalence of the PLR in maxillary sinus was investigated and the thickness of its medial bony wall was measured and statistically assessed. Meanwhile, the width of the PLR was measured. The correlation between the width of the PLR and its medial bony wall thickness was assessed. The data were compared between the left side and right side, male and female. The PLR was present in 82.5% of the maxillary sinus, with no significant differences between the left and right sides, as well as different gender groups. The mean thickness of the medial bony wall of the PLR was 2.84 ± 1.41mm, without statistical difference between the left and right sides but significantly larger in males than in females. The mean width of the PLR was 4.62 ± 1.74mm and it had a significant negative correlation with the thickness of the medial bony wall of the PLR. A large individual variation exists in the anatomy of PLR, including its prevalence and dimensions of its medial bony wall. When considering the intranasal endoscopic prelacrimal recess approach, the surgeons should carefully evaluate the anatomical structure of the PLR preoperatively so as to minimize the risks of surgical complications.