Nasolacrimal Canal Research Articles

The nasal and paranasal architecture of the Middle Miocene ape Pierolapithecus catalaunicus (primates: Hominidae): Phylogenetic implications

The internal (nasal and paranasal) cranial anatomy of the Middle Miocene (11.9 Ma [millions of years ago]) great ape Pierolapithecus catalaunicus (Hominidae: Dryopithecini) is described on the basis of computed-tomography scans of the holotype specimen (IPS21350), with particular emphasis on its phylogenetic implications. Pierolapithecus displays the following characters: an anteriorly-restricted maxillary sinus that posteriorly spreads towards the ethmoidal area (thus resembling the pongine condition), although being situated well above the molar roots (as in kenyapithecins, other dryopithecins and pongines); lack of frontal sinus (a synapomorphy of derived pongines, independently acquired by both cercopithecoids and hylobatids); posteriorly-situated turbinals (as in Pongo); anteriorly-projecting nasolacrimal canal (as in Pongo); and probably stepped nasal floor with non-overlapping premaxillary–maxillary contact (as in dryopithecines and stem hominoids, although it cannot be conclusively shown due to bone damage). Overall, Pierolapithecus displays a mosaic of primitive hominid and derived pongine features that are inconsistent with this taxon being a hominine (as previously suggested). Two alternative phylogenetic interpretations are possible: Pierolapithecus may be a stem member of the Hominidae as previously suggested in its original description, or alternatively this taxon may be a stem member of the Ponginae s.l. (with the European dryopithecines being the sister taxon to the Asian pongines).

Congenital Dacryocystocele

A full-term baby girl showed a bluish mass at birth in the right medial canthal area. She later demonstrated dacryocystitis and cellulitis. Although probing was performed, it was unsuccessful, and the dacryocystitis and cellulitis worsened. Computed tomography showed a dilated lacrimal sac, an enlarged nasolacrimal canal and a nasal cyst. Topical and intravenous systemic antibiotics were then started, and the symptoms partially subsided. Surgery was performed under general anesthesia with endoscopic assistance, under which cystic distention was visualized beneath the inferior turbinate. A dacryoendoscope showed injection and hemorrhages on the inner wall of the cyst. Marsupialization of the cyst was performed. Histopathologic examination showed submucosal tissue including fibrous thickening with infiltration of mononuclear leukocytes. The patient remained symptom free 6 months thereafter. Dacryoendoscopy for a congenital dacryocystocele demonstrated injection with hemorrhages, and this inflammatory sign corresponded to the histopathologic findings.

Nasolacrimal relapse of nasopharyngeal carcinoma

To describe three rare cases of nasolacrimal relapse of nasopharyngeal carcinoma, and to discuss the route of tumour spread from nasopharynx to lacrimal system as well as the relevant computed tomography findings. We report three cases of nasolacrimal relapse in patients with previously treated nasopharyngeal carcinoma. The common initial presentations in these cases were epiphora and medial canthal swelling. The tumour spread from the nasopharynx to the lacrimal sac along the lateral nasal wall and nasolacrimal canal. Computed tomography demonstrated nasolacrimal canal invasion and osteomeatal complex obliteration by the tumour. Distant metastasis was detected in two cases. More targeted radiotherapy should be delivered to prevent under-treatment of nasopharyngeal carcinoma. Nasolacrimal relapse of nasopharyngeal carcinoma is an advanced disease with a poor prognosis.

Deficit trasversale del mascellare superiore e problematiche relative all’orecchio medio

ObjectivesRestriction of the maxillary dental arch frequently results in decreased nasal canal patency with mouth breathing, and this situation may also be associated with conductive hearing loss. The aim of this paper is to review some of the literature on this condition and to advance several hypotheses regarding the changes observed in conductive hearing loss following orthodontic-orthopedic treatment. Materials and methodsA literature review was carried out to critically analyze the relationship between “rapid maxillary expansion” and “improvement in conductive hearing loss”. ResultsThe limited data in the literature on this specific topic suggest that hearing levels can be improved by correction of the palatal anatomy. ConclusionsThe positive effect on conductive hearing levels can be considered a possible additional benefit of rapid maxillary expansion, but this does not mean that rapid maxillary expansion should be proposed as a treatment for conductive hearing loss that is not associated with maxillary restriction.

Computed tomography dacryocystography research of nasolacrimal duct of unilateral congenital nasolacrimal obstruction

Background The three-dimensional configuration of the nasolacrimal canal is highly variable with age,gender,and race.But enlargement of the nasolacrimal canal has sparsely been reported in the literature.Objective Computed tomography dacryocystography was performed in patients with unilateral congenital nasolacrimal duct obstruction and normal children to analyze the difference of bilateral nasolacrimal canal. Methods This is a retrospective study.Axial scan with sagittal and coronal reconstruction was applied in computed tomography dacryocystography.Diameters of bilateral nasolacrimal canal of 20 unilateral congenital nasolacrimal duct obstruction patients and 20 normal children were measured.Written informed consent was obtained from each child ' s parents before examination. Results The lacrimal sac,nasolacrimal duct and the peripheral tissue were clearly exhibited by computed tomography dacryocystography.The diameters of the origination,the middle part and the distal end of affected nasolacrimal duct were(5.5±1.4),(5.3±1.2),(5.3±1.6) mm,and normal ones were(3.9±0.8 ),(3.5± 0.8 ),( 3.9± 1.3 ) mm,respectively.These results were statistically significant ( t =5.200,6.967,2.932,P＜ 0.05 ).There was no statistically significant difference in bilateral nasolacrimal canal of normal children (t =0.346,0.281,0.312,P＞0.05 ). Conclusions Computed tomography dacryocystography can image lacrimal passage and their peripheral tissues clearly.The affected nasolacrimal canal diameters of unilateral congenital nasolacrimal duct obstruction were much larger than the fellow sides.The pathogenesis of this phenomenon need much research. Key words: Nasolacrimal obstruction/congenital/unilateral; Computed tomography; Dacryocystography; Nasolacrimal canal

Anatomical and Morphometric Study of the Bony Nasolacrimal Canal Using Computed Tomography

Aims: To determine the diameters, angles and sectional area of the bony nasolacrimal canal using computed tomography for obtaining detailed anatomical knowledge of the drainage system and utilizing these measurements in planning interventions for nasolacrimal duct obstruction in adults and children. Methods: Using standard computed tomographic images, we measured the diameters, angles and sectional area of the bony nasolacrimal duct in 228 patients without nasolacrimal duct disease. Results: There was no statistically significant difference in other parameters between males and females. In particular, age had a significant effect on the angle between the bony nasolacrimal canal and the nasal floor in the pediatric patients (<10 years; p = 0.00), and pediatric patients had more acute angles than adult patients (>10 years old). Conclusions: In nasolacrimal probing of congenital nasolacrimal duct obstruction, the probe should be passed more to the posterior part of the nasal cavity. In other words, the distal part of the probe should form a more obtuse angle with the forehead in pediatric patients than in adults. This study may contribute to the establishment of a detailed anatomical and morphometric baseline of the bony nasolacrimal canal and provide useful information for the planning of interventions for nasolacrimal duct obstruction in adults and children.

Bony Nasolacrimal Duct Entrance Diameter: Gender Difference in Cadaveric Study

To examine gender differences in bony nasolacrimal canal entrance diameters in cadavers. Fifty-seven orbits from 29 Japanese cadavers (37 orbits from 19 men and 20 orbits from 10 women), aged 61 to 96 years at death (mean: 79.5 years; men: 77.8 years; women: 82.7 years), were fixed in 10% buffered formalin. The anteroposterior and transverse diameters of the bony nasolacrimal canal entrance were measured. The diameters were compared between genders using Student's t test. The mean anteroposterior diameters in all subjects, men, and women, were 6.9, 6.8, and 7.2 mm, and the equivalent transverse diameters were 5.7, 6.1, and 5.0 mm, respectively. There was no significant gender difference in the anteroposterior diameter (p = 0.287), but the transverse diameter was significantly shorter in women than in men (p = 0.004). The transverse diameter of the bony nasolacrimal canal entrance was significantly shorter in women than in men, which may be a possible factor contributing to the higher incidence of primary acquired nasolacrimal duct obstruction in women.

Anastomosing of fractured lacrimal canaliculi by the direct intubation with epidural catheter and acupuncture needle under the microscope

Objective To investigate the method and experience of the lacrimal canalicular anastomosis by the direct intubation with epidural catheter and acupuncture needle under the microscope. Methods It was retrospective case series study. 35 cases of the traumatic laceration of lacrimal canaliculus in the emergency department of Beijing Tongren Hospital were involved. As we worked to identify the proximal broken end of lacrimal canaliculus with the help of a microscope, we emplogyed acupuncture needles and epidural catheters as holdfasts and inserted them into the lacrimal canaliculus. Ultimately they were pushed further into the inferior canal of the nasal cavity. We ended up pulling out the epidural catheter through the lacrimal puncta with a pigtail probe,and the epidural catheter was sutured and fixed. Results The surgical alternative worked out well on 33 out of the 35 cases recorded. Of the 33 successful cases, the lacrimal canaliculus was found unbocked when the epidural catheter was pulled out 3 months later and remained unblocked for 94% of the cases in follow-up check-ups 6 months after the operation. Conclusion The key of the surgery is how to search rupturednasal canaliculus and insert the holdfast in the inferior nasal canal. Anastomosing of fractured lacrimalis canaliculi by direct intubation with epidural catheter and acupuncture needle under the microscope, offers a simple yet highly effective approach. Key words: lacrimal canaliculus; anastomosis; acupuncture needle; epidural catheter; microscope

Preservation of the nasolacrimal duct during endoscopic medial maxillectomy for sinonasal inverted papilloma

To assess the efficacy of a new endonasal medial maxillectomy technique (EMM) for the treatment of inverted papilloma (IP). A prospective series of 55 consecutive patients diagnosed with IP between March 2002 and April 2009 were entered into this study. The new surgical technique was applied to tumors arising from the anterior part of the maxillary sinus. After conventional EMM, the entire nasolacrimal duct was separated from the bony component of the nasolacrimal canal and preserved. Schirmer`s test and a visual analog scale (VAS) score were used to assess the lacrimal duct function after surgery. Ten of the 55 patients underwent the new surgical procedure. All patients were categorized with stage T3 or T4 tumors. No patients suffered tumor recurrence. There was no difference in lacrimal duct function between the diseased side and healthy side of the nasolacrimal duct. The mean VAS score was 2.8/100. This new surgical technique preserves the whole length of the nasolacrimal unit. It also offers several advantages including good visualization, nasolacrimal function after surgery and fewer adverse effects such as facial numbness and epiphora.

Observation on the clinical effect of high-frequency electrolacryocystoplasty combining with silicone draining device intubation in the treatment of lacrimal passage obstruction

Objective To observe the clinical effect of high—frequency electrolacryocystoplasty combining with silicone draining device intubation in the treatment of lacrimal passage obstruction.Methods High—frequency electrolacryocystoplasty was performed in 61 patients(78 eyes) with the diagnosis of lacrimal passage obstruction.Silicone lacrimal passage draining device was put into the nasolacrimal canal under the guiding of metallic probes in both ends.The tube was retained in the nasolacrimal canal for 2.5 to 6.5 Months before its removal.Results The silicone tube was kept in nasolacrimal canal for 2.5 to 6.5 Months (mean 3.66 months).Mean follow—up time after tube removal was 10.62 months.57 eyes (73.08%) were cured and 8 eyes (10.25%) were improved and 13 eyes(16.67%) recurred.The overall successful rate was 83.33%.Conclusion It is an effective and simple treatmente for lacrimal passage obstruction ，with its less invasive and complication as well as high successful rate.

Is it necessary to accompany probing with endoscopy in cases of congenital nasolacrimal canal obstruction?

Objective To compare the results of probing with and without endoscopy in cases of congenital nasolacrimal duct obstruction who had previously not undergone probing. Methods Fifty-one children with congenital nasolacrimal duct obstruction who underwent surgical intervention between June 2007 and April 2009 in our hospital were included in the study. Patients who had had previous probings were excluded from the study. Conventional probing was performed in 37 eyes of 25 patients, and probing with intranasal endoscopic visualization in 36 eyes of 26 patients. Diagnosis was based on history of epiphora since birth or shortly after, and fluorescein dye disappearance test. Results Thirty-two of 37 eyes (86.48%) were cured by probing. Of the 5 cases with complaints, 1 had lacrimal sac fistula. Thirty-four of 36 eyes (94.44%) were cured by probing guided by endoscope observation. Thirty-two cases had stenosis at the lower end of the nasolacrimal duct which required probing. In two cases the probe passed submucosally to the floor of the nose. In two cases a false passage was made at the upper end of the inferior meatus. In these cases, the operation was continued by repeating the process until the distal end of the nasolacrimal canal was seen to have been passed. Conclusion Probing with endoscopy may be excessive in primary cases but in cases which have undergone unsuccessful probing, it is useful for visualization of anomalies in the lower nasolacrimal canal and to obtain the correct anatomic position for the probe.

Primary external dacryocystorhinostomy versus primary endonasal dacryocystorhinostomy: a review

This paper aims to compare the efficacy, mean operative time and adverse effects of primary external dacryocystorhinostomy (DCR) versus primary endonasal DCR in treating acquired nasolacrimal duct obstruction. Searches were performed for studies comparing the two procedures. Two reviewers independently extracted data from 14 eligible studies. A random effects model was used to analyse the studies. Outcome measures were defined as patency of the nasolacrimal canal and mean operative time,and adverse effects as cutaneous scarring and bleeding.Both procedures were comparable in efficacy in terms of full success, partial success and anatomic patency. Subgroup analysis showed no significant difference between prospective and retrospective studies as well as between non-laser endonasal DCR versus external DCR and laser endonasal DCR versus external DCR. Endonasal DCR had a significantly shorter mean operative duration, be it laser endonasal DCR (mean difference: 37.65 min, 95% confidence intervals:3.54-71.75 min, P: 0.03) or non-laser endonasal DCR (mean difference: 19.22 min, 95% confidence intervals: 2.15-36.28 min, P: 0.03). The odds of post-operative bleeding was not significantly different between the two procedures, whereas post-operative cutaneous scarring was unique to external DCR and occurred in 50 out of 402 (12.44%) external DCRs recorded. Endonasal DCR has comparable success rates with external DCR and has a shorter operative time and no cutaneous scar. However, drawbacks include the steep learning curve and higher costs.

The maxillary bone and its dental and soft tissue interfaces in newborn primates

Midfacial morphology is strikingly different between higher taxonomic groups of primates. Compared to strepsirrhines (e.g., lemurs), haplorhines (e.g., monkeys, tarsiers) possess a greater magnitude of orbital convergence relating to evolutionary trends in the special senses. To understand the development of this dichotomous morphology, we examined serially sectioned newborn heads of a monkey (Saguinus sp), tarsier (Tarsius sp) and lemur (Eulemur sp). We have characterized the spatial arrangement of the dental sacs and orbitonasal soft tissue matrices relative to the maxilla, and assessed bone cell distribution to identify resorptive and depositional surfaces of the adjacent bone. Position of the dental sacs, infraorbital canal, nasolacrimal duct, and paranasal cavities differs among species. For example, deciduous premolars are positioned relatively laterally in Saguinus compared to other taxa. Regionally, this corresponds to resorption of the medial alveolar wall, a shared boundary with the maxillary sinus. Differences in spatial association of the nasolacrimal canal, infraorbital canal, and maxilla corresponds to species‐specific patterns of bone cell distribution. These phylogenetic variations ultimately relate to major evolutionary trends of soft tissues (e.g., special sense organs) and dentition, and offer unique natural experiments to understand mechanisms of midfacial growth.

Morphology of lateral line canals in Neotropical freshwater stingrays (Chondrichthyes: Potamotrygonidae) from Negro River, Brazilian Amazon

The relationship between the distribution of the lateral line canals and their functionality has not been well examined in elasmobranchs, especially among Neotropical freshwater stingrays of the family Potamotrygonidae. The spatial distribution of the canals and their tubules and the quantification of the neuromasts were analyzed in preserved specimens of Potamotrygon motoro, P. orbignyi, Potamotrygon sp. "cururu", and Paratrygon aiereba from the middle Negro River, Amazonas, Brazil. The hyomandibular, infraorbital, posterior lateral line, mandibular, nasal and supraorbital canals were characterized and their pores and neuromasts quantified. The ventral canals are known to facilitate the accurate localization of prey items under the body, and our results indicate that the dorsal canals may be employed in identifying the presence of predators or potential prey positioned above the stingray's body. The presence of non-pored canals in the ventral region may be compensated by the high concentration of neuromasts found in the same area, which possibly allow the accurate detection of mechanical stimuli. The concentration of non-pored canals near the mouth indicates their importance in locating and capturing prey buried in the bottom substrate, possibly aided by the presence of vesicles of Savi.

Anastomosis of nasal mucosal and lacrimal sac flaps in endoscopic dacryocystorhinostomy

Endoscopic dacryocystorhinostomy (DCR) is a well-established alternative to external approaches in the treatment of nasolacrimal canal obstruction. From July 2004 to December 2008, 92 endoscopic DCRs were performed on 88 patients at the Department of Otorhinolaryngology, San Raffaele Hospital, Milan. All patients were affected by chronic dacryocystitis with epiphora. Preoperative work-up included Jones tests, lacrimal pathways irrigation, nasal endoscopy, and imaging evaluation by computed tomography. The technique involved anastomosis of nasal mucosal, lacrimal sac flaps and a large bony ostium. A silicone tube was inserted in all patients that remained for a period of 3 months. The first endoscopic intervention was successful in 91.30% of patients. After a second revision endoscopic DCR, the overall success rate raised to 95.65%. Anastomosis of nasal mucosal between lacrimal sac flaps plays a key role in endoscopic DCR with a high success rate both in primary nasolacrimal obstructions and in revision cases.

The diameter of the nasolacrimal canal measured by computed tomography: gender and racial differences

The incidence of dacryocystorhinostomy surgery among Pacific People is greater than would be expected given their proportion in the population. Some have suggested that racial and sex differences in facial skull dimensions produce narrower nasolacrimal canals and therefore differences in the incidence of primary acquired nasolacrimal duct obstruction (PANDO). We measured the minimum diameter of the canal in those not known to have PANDO. A retrospective review of the digital computed tomography (CT) database was performed. Minimum diameter of the nasolacrimal canal on axial cuts of a sinus series CT scan was measured. Sex and racial origin were recorded. All series on the database were included. Absence of axial images and pathology distorting the canal excluded a patient. This was carried out in the Department of Radiology and Ophthalmology, Greenlane Medical Centre, Auckland. A total of 178 CT scans were included. Men had a mean diameter of 3.9 mm (95% confidence interval [95%CI]: 3.8-4.1) versus women 3.6 mm (95%CI: 3.5-3.8) P = 0.01. Both Caucasian and New Zealand Maori had mean diameters of 3.7 mm (95%CI: 3.5-3.9) whereas Pacific People were 4.1 mm (95%CI: 3.9-4.3) P = 0.01. As in other studies women had narrower canals than men. Surprisingly we found no difference between New Zealand Maori and Caucasian. Unexpected was the larger diameter in Pacific People, as they have a higher incidence of dacryocystorhinostomy surgery. PANDO is likely to be of multifactorial aetiology and nasolacrimal canal diameter may not be a significant factor. Our described method of measuring canal diameter by CT scan is comparable to a cadaver study.

Diagnosis and therapy of lacrimal system diseases by micro lacrimal endoscope

The lacrimal endoscope is applied to the diagnosis and therapy of the disorders of the lacrimal system in combination with laser or micro drills under orthophoria. The changes of mucous membranes, the characteristics of pathological changes and the predilection sites of lacrimal system diseases were initially approached. One hundred and forty six pairs of eyes of 128 patients with lacrimal system disease were observed by the lacrimal endoscope in the Ophthalmology Department of Tongji Hospital from June 2006 to March 2007. The dynamic changes in mucous membranes, lesion sites, secreted substances and formation of membrane could be observed under orthophoria. Combined with laser or micro drill, the endoscope was applied to the therapy of lacrimal system disorders and the difference before and after the treatment was observed. Results are as follows: (1) The examination and therapy using the lacrimal endoscope were completed under topical anesthesia in 122 patients, and 6 patients of neonatorum dacryocystitis were examined and treated under general anaesthesia. All patients reported painless. (2) Sharp images of the lacrimal system were obtained by the endoscope. Normal lacrimal mucosal membrane was smooth and light pink, expanded and unobstructed during irrigation. In chronic dacryocystitis patients, the inhomogeneous colour of mucosal membranes was red and white, with different degrees of fibrotic membranes at the superior, middle and inferior parts of the nasolacrimal canals and secreted substances at sac could be observed. The lacrimal ducts could not be expanded and obstructed during irrigation. The patients with lacrimal system obstruction had different extents of membrane formation, and stenosis or complete obstruction of the lacrimal duct could be observed, and the corresponding mucosal membrane was not smooth which could not be expanded and obstructed during irrigation. (3) After the treatment by the endoscope combined with laser or micro drill, the major proliferation of the membrane disappeared and the lacrimal duct was unobstructed during irrigation. The cure rate and effective rate were 80.1% and 93.1%, respectively. The lacrimal endoscope is a new method in the diagnosis of lacrimal system diseases. Through a combination with laser or micro drill to carry out the therapy under orthophoria, it will bring a great change to the diagnosis and therapy of lacrimal system diseases.

Surgical Treatment of Familial Dacryocystocele and Lacrimal Puncta Agenesis

Bilateral agenesis of the lacrimal puncta and enlargement of the nasolacrimal canal are rare anatomic variants. The authors present 2 familial cases: a 39-year-old woman with bilateral dacryocystocele and lacrimal puncta agenesis and her 46-year-old brother, who had a long history of epiphora and recurrent dacryocystitis, and also had bilateral lacrimal puncta agenesis and a left dacryocystocoele. The authors report the endoscopic, CT, and MRI findings, and describe the surgical treatments, by endoscopic dacryocystorhinostomy in the first case, and conjunctivodacryocystorhinostomy with Jones tube in the second case. At 24 months after surgery, both patients' symptoms were improved.

Malignes Melanom des Tränensacks

A 68-year-old woman presented with a 10-month history of right-sided epiphora, bloody tears, and medial canthal mass. Computed tomography revealed a soft tissue mass of the right lacrimal sac with widening of the bony nasolacrimal canal. External dacryocystorhinostomy with incisional biopsy confirmed the diagnosis of malignant melanoma. After staging, further therapy included orbital exenteration, lateral rhinotomy with en bloc resection of the lacrimal drainage apparatus, and adjuvant radioimmunotherapy. One year after surgery, no evidence of local recurrence or metastatic disease could be detected.

A Proposal for a New Classification and Nomenclature for the Glires (Lagomorpha and Rodentia)

The integrity of the Cohort Glires is supported, not only by the numerous previously noted synapomorphies (e.g. distinctive embryology, caecotrophy, evergrowing gnawing incisors) but by new ones (rectangular cross section of rostrum, distance of jaw articulation from middle ear). Lagomorphs are considered highly modified grazing animals derived from a rodent-like ancestor with fully developed gnawing incisors. Zygomasseteric structure is abandoned as the basis for the classification of the Rodentia. The relation of the nasolacrimal canal to the incisor alveolous is the basis for a dichotomy between the Entodacrya, in which the canal runs medial to the alveolus, and the Sciurognathii, in which the canal is lateral (plesiomorphic condition). Entodacrya divide into Ctenodacylida (from which Cocomys has been removed) and Hystricognathii. The Sciuromorpha divide into the Stegaulata, in which the nasolacrimal canal is buried the skull, and the Phaneraulata, in which the canal lies open on the face for some distance. The Stegaulata are roughly the old Sciuromorpha, minus the geomyoids and plus the anomalurids and the paramyids. The Phaneraulata are approximately the old Myomorpha, minus the anomalurids and plus the geomyoids, the glirids, and the Theridomyids. Pedetes may form the sister group to the Entodacrians.