Intranasal location of lacrimal sac in Thai cadavers

2010 ◽  
Vol 4 (2) ◽  
pp. 323-327
Author(s):  
Napas Tanamai ◽  
Teeraporn Ratanaanekchai ◽  
Sanguansak Thanaviratananich ◽  
Kowit Chaisiwamongkol ◽  
Thanarat Chantaumpalee
Keyword(s):  
Middle Turbinate ◽  
Anterior Wall ◽  
Posterior Border ◽  
Lacrimal Sac ◽  
Endoscopic Dacryocystorhinostomy ◽  
Exact Boundary ◽  
Khon Kaen ◽  
The Mean

Abstract Background: Many current literatures have described that the lacrimal sac is located just anterior to the anterior attachment (axilla) of the middle turbinate. However, there was no data on the exact boundary of the sac, especially the distance related with a permanent landmark such as the middle turbinate attachment. Objective: Determine the intranasal location of the lacrimal sac related to the middle turbinate attachment in Thai fresh cadavers. Methods: The study was performed in 26 Thai fresh cadavers, donated to Khon Kaen University, Thailand between July 2006 and July 2007. The height and width of the lacrimal sac were recorded, as well as the distances from the upper, lower, anterior and posterior border of the lacrimal sac to the axilla of the middle turbinate were measured. Results: The mean height and width of 52 lacrimal sacs were 11.2 and 6.2 mm. The mean distances from the upper, lower, anterior, and posterior border of lacrimal sac to the axilla of the middle turbinate were 4.9 mm (95%CI=4.4-5.4), 5.6 mm (95%CI=5.1-6.1), 3 mm (95%CI=2.4-3.6), and 2.9 mm (95%CI=2.3-3.5), respectively. The upper border of all lacrimal sacs were located superior to the axilla of the middle turbinate (95%CI=93.1-100), and posterior border of 44 sacs (85%, 95%CI=72.5-92.0) were located posterior to the axilla. Additionally, the anterior wall did not extend anterior to the anterior attachment of the middle turbinate in 21% of the sac. Conclusion: This study revealed the more exact intranasal location of lacrimal sacs. This is useful for surgeons to perform adequate endoscopic dacryocystorhinostomy to prevent postoperative lacrimal sump syndrome.

scholarly journals Stent technique for endoscopic dacryocystorhinostomy – Our expertise

2016 ◽  
Vol 6 (21) ◽  
pp. 23-27
Author(s):  
Vlad Budu ◽  
Tatiana Decuseara ◽  
Bogdan Mocanu ◽  
Raluca Baican ◽  
Mihai Tusaliu ◽  
...  
Keyword(s):  
Success Rate ◽  
Lacrimal Sac ◽  
Lacrimal Duct ◽  
Bottom Edge ◽  
Duct Obstruction ◽  
Endoscopic Dacryocystorhinostomy ◽  
Lacrimal Apparatus ◽  
The Mean ◽  
Surgery Department ◽  
The Ideal

Abstract BACKGROUND. Endoscopic dacryocystorhinostomy is known to be the ideal treatment for saccal and postsaccal stenosis of the lacrimal apparatus. Following this surgery, an important inconvenient would be the stenosis of the created ostium with consecutive epiphora. MATERIAL AND METHODS. 20 patients with chronic unilateral lacrimal duct obstruction were operated in “Prof. Dr. D. Hociota” Institute of Phono-Audiology and Functional ENT Surgery, Department I, between January 2015 and July 2015. After creating the dacryocystorhinostoma, a stent was inserted transnasally to the bottom edge of the lacrimal sac and positioned to the bony margin of the ostium. Stents used varied in size from 1 to 3 mm in diameter. We followed-up our patients at 2 weeks and 1, 3, 6 months, assessing the symptoms of the lacrimal apparatus, especially the epiphora. RESULTS. The mean age of patients varied between 31 and 65. Most of our patients were women (n=14). In a total number of 16 patients epiphora disappeared, it decreased in 2 patients, and persisted in 2 patients. There were two patients with no changes who have spontaneously eliminated the stent 2 or 3 days after the surgery. The most widely used stent size was 3 mm diameter, with a success rate of 90%. CONCLUSION. The endoscopic approach may be an effective procedure in patients with pathologies of the lacrimal apparatus. In order to achieve an efficient result, both a preoperative rigorous preparation and also postoperative medical care are necessary. In conclusion, ostium stenting represents a better way to ensure a longer period of maintaining the permeability of the lacrimal apparatus.

Endoscopic Localization of the Anterior and Posterior Ethmoid Arteries

2008 ◽  
Vol 117 (12) ◽  
pp. 931-935 ◽  
Author(s):  
Joseph K. Han ◽  
Samuel S. Becker ◽  
Steven R. Bomeli ◽  
Charles W. Gross
Keyword(s):  
Skull Base ◽  
Sphenoid Sinus ◽  
Image Guidance ◽  
Middle Turbinate ◽  
Anterior Wall ◽  
Guidance System ◽  
External Incision ◽  
The Mean ◽  
Endoscopic Localization ◽  
Anterior Ethmoid Artery

Objectives: Understanding the endoscopic locations of the anterior and posterior ethmoid arteries is important during endoscopic sinus or endoscopic skull base procedures so that these arteries can be avoided. Therefore, the objective of this study was to define the endoscopic locations of the ethmoid arteries. Methods: Twenty-four cadaver heads were used to identify the endoscopic location of the ethmoid arteries via an external incision. An image guidance system was used to record the locations of these arteries. The anterior ethmoid artery was referenced to the axilla of the middle turbinate, and the posterior ethmoid artery to the anterior wall of the sphenoid sinus. The closest lamella to these arteries was identified. Results: Forty-eight nasal cavities were dissected. The mean distance from the axilla to the anterior ethmoid artery was 17.5 mm. The anterior ethmoid artery was located immediately anterior to (31%), at (36%), or immediately posterior to (33%) the superior attachment of the basal lamella. The mean distance from the posterior ethmoid artery to the anterior ethmoid artery was 14.9 mm. The mean distance from the posterior ethmoid artery to the anterior wall of the sphenoid sinus was 8.1 mm. The posterior ethmoid artery was either anterior to (98%) or at (2%) the anterior face of the sphenoid sinus. Conclusions: Specific endoscopic anatomic relationships and measurements have been presented for the anterior and posterior ethmoid arteries.

scholarly journals Surgical anatomy of the posterior ends of the middle and inferior turbinates

2016 ◽  
Vol 05 (04) ◽  
pp. 209-218
Author(s):  
Gayatri Girish Muthiyan ◽  
Shanta Sunil Hattangdi ◽  
Payal Arvind Kasat
Keyword(s):  
Hard Palate ◽  
Middle Turbinate ◽  
Inferior Turbinate ◽  
Surgical Anatomy ◽  
Endoscopic Intervention ◽  
Guiding Principle ◽  
Line Passing ◽  
The Mean ◽  
Lowermost Portion

Abstract Background: Preservation of structure and reestablishment of function is the guiding principle during an endoscopic intervention. Especially, when a partial middle turbinectomy is unavoidable, middle turbinate can lose its stability. Variations of middle turbinate like severe anterior bulging, posterior protrusion beyond the inferior turbinate and the larger size than inferior turbinate have significant impact on its stability. Aim: To study surgical anatomy of the middle and inferior turbinates. Method: The distances and angles between the limen nasi and posterior ends of the middle and inferior turbinates were studied in 100 hemisected adult Indian cadaveric heads. Results: The mean angles between the line passing through the lowermost portion of limen nasi and posterior ends of middle turbinate and inferior turbinate respectively are bl was 19.87° and b2 was 10.57°. The mean distance between the lowermost portion of limen nasi and posterior ends of middle turbinate and of inferior turbinate were xi is 55.88 ± 3.61 mm and x2 was 52.69 ± 3.57 nnn.The mean distances between the lowermost portion of limen nasi and the perpendicular from the posterior ends of middle turbinate and inferior turbinate to the hard palate were yl= 52.47 ± 3.33 mm (range: 44.16 to 59.92 mm) and y2= 51.75 ± 3.45 mm (range 43.32 to 61.22 mm) respectively. In 52% cases middle turbinate extends more posterior with respect to inferior turbinate i.e.M > I and in 48% cases inferior turbinate extends more posterior with respect to middle turbinate of M < I. Conclusion: The documentation of these parameters and the related variations is likely to be useful for the endoscopic surgeons.

Sinus Irrigation Penetration After Proposed Modified Draf IIa Technique in a Side-to-Side Cadaveric Model

2020 ◽  
pp. 194589242096914
Author(s):  
Khalil Issa ◽  
Jordan I. Teitelbaum ◽  
David W. Jang ◽  
Bradley J. Goldstein ◽  
Lyndon Chan ◽  
...  
Keyword(s):  
Frontal Sinus ◽  
Middle Turbinate ◽  
Contralateral Side ◽  
Sinus Surgery ◽  
Ordinal Scale ◽  
Fresh Cadaver ◽  
The Mean ◽  
Procedural Modification ◽  
Proposed Modification ◽  
Cadaveric Model

Background Endoscopic sinus surgery (ESS) is an effective intervention for patients with medically refractory chronic rhinosinusitis. Frontal sinusotomy is the most challenging part of ESS, with one of the key outcomes being access for topical irrigations. Objective The purpose of this study is to compare irrigation penetration into the frontal sinus following Draf IIa versus modified Draf IIa frontal sinusotomy. Methods Four fresh cadaver heads were used in this experiment. Draf IIa was performed on one side of each head and a modified Draf IIa on the contralateral side. This proposed modification consists of a Draf IIa combined with an agger nasi punch-out procedure and partial trimming of the vertical lamella of the middle turbinate back to the posterior table of the frontal sinus without drilling the beak. Each head was irrigated with methylene blue-dyed water and recorded by rigid endoscopy through an endonasal view (EV) of the frontal sinus and frontal trephination view (TV). Two blinded rhinologists scored the extent of staining (using an ordinal scale of 0 to 3) for each side. A case report where the modified Draf IIa was performed is also described. Results After modified Draf IIa sinuosotomy, the mean score for the EV was 2.125 and for the TV was 2, versus 0.875 and 0.625 for traditional Draf IIa, respectively. There was a statistically significant increase for both EV (p = 0.019) and TV (p = 0.018) after modified Draf IIa. Conclusion In our cadaveric model, this procedural modification improved penetration of postoperative irrigations into the frontal sinus. This simple technique may be easily adapted into frontal ESS when indicated.

Role of endoscopic dacryocystorhinostomy in treating acquired lacrimal fistulae

2003 ◽  
Vol 117 (10) ◽  
pp. 793-795 ◽  
Author(s):  
Sanjay Subbaiah
Keyword(s):  
Retrospective Analysis ◽  
Lacrimal Sac ◽  
Endoscopic Dacryocystorhinostomy ◽  
Successful Outcomes ◽  
Lacrimal Fistula

Acquired lacrimal fistula occurs in an improperly and inadequately treated lacrimal sac abscess. This study was done to evaluate the success of endoscopic dacryocystorhinostomy (EDCR) in treating such lacrimal fistula. A retrospective analysis of nine cases of acquired lacrimal fistulae in seven patients, treated by EDCR without any external surgery was carried out. Cessation of epiphora and closure of fistula were considered, successful outcomes. All the nine fistulae closed, and all patients were relieved of their epiphora within two weeks of surgery. It can be concluded that EDCR is effective for treating an acquired lacrimal fistula.

scholarly journals The Fibrin Glue Application Enhances Surgical Success Rate in Endonasal Endoscopic Dacryocystorhinostomy With Lacrimal Sac Preservation

2019 ◽  
pp. 014556131988212 ◽  
Author(s):  
Seyit Mehmet Ceylan ◽  
Ceren Erdoğan ◽  
Tevfik Sozen ◽  
Mahmut Alper Kanmaz ◽  
Ilyas Disikirik ◽  
...  
Keyword(s):  
Success Rate ◽  
Fibrin Glue ◽  
Complication Rate ◽  
Anastomosis Group ◽  
Lacrimal Sac ◽  
Endoscopic Endonasal ◽  
Subjective Report ◽  
Positive Functional ◽  
Surgical Success ◽  
Endoscopic Dacryocystorhinostomy

The purpose of this study to compare lacrimal sac flap preserving techniques with or without fibrin glue in patients undergoing endoscopic endonasal dacryocystorhinostomy. A retrospective study included 132 patients who underwent unilateral endonasal dacryocystorhinostomy between February 2011 and March 2016. Patients were divided into 2 groups: the nonfibrin glue group (n = 66) and fibrin glue anastomosis group (n = 66). Surgical success was defined as the patients’ subjective report of relief of epiphora and objective endoscopic confirmation of ostium patency confirmed by a positive functional dye test. These parameters were compared between the 2 groups. Both groups were similar, in terms of demographic and clinical characteristics. The surgical success rate was significantly higher in the fibrin glue anastomosis group (95.5%) than in the nonfibrin glue group (84.8%; P = .041). Complication rate was 6.1% in the nonfibrin glue group, whereas in the fibrin glue anastomosis group, it was 4.5%. The complication rate was similar in both groups ( P = .99). Creation of an anastomosis between the lacrimal sac flaps and the nasal mucosa using fibrin glue improves the outcome of endonasal endoscopic dacryocystorhinostomy.

Surgical Anatomy of Nasolacrimal Duct and Sac in Human Cadavers

2014 ◽  
Vol 7 (3) ◽  
pp. 91-95 ◽  
Author(s):  
Tulika Gupta ◽  
Suhalika S Sahni ◽  
Ruchi Goyal
Keyword(s):  
Average Length ◽  
Average Distance ◽  
Vertical Plane ◽  
Inferior Turbinate ◽  
Average Diameter ◽  
Nasolacrimal Duct ◽  
Surgical Anatomy ◽  
Lacrimal Sac ◽  
Human Cadavers ◽  
The Mean

ABSTRACT Background Surgical importance of the nasolacrimal duct (NLD) for both otolaryngologists and ophthalmologists cannot be overemphasized. Injury to this structure can lead to iatrogenic epiphora, synechiae formation and need for secondary lacrimal diversion procedures. Materials and methods The present study was conducted on 27 mid-sagittal sections of head and neck of formalin fixed adult cadavers. The inferior opening of the NLD was identified and exposed. The duct and the lacrimal sac were dissected. Pertinent distances of the inferior opening of the NLD from the easily identifiable surgical landmarks were recorded, so as to accurately locate the inferior opening of the duct using a digital vernier calliper (accuracy 0.02 mm, Mitutoya, Japan). Various dimensions and angulation of the duct and lacrimal sac were measured. Results The average length of NLD was 11.42 ± 2.45 mm and it was making an angle of 20° with the vertical plane. The duct was narrowest in caliber in its upper 1/3rd in majority (82%) of the cases. The average diameter of the inferior opening of the NLD was 3.14 mm. In two cases (7.4%), the opening was only 1.8 mm wide. The mean distance of the inferior opening of the duct was 20.7 mm from the columella, 25.5 mm below the skull base and 16.5 mm above the hard palate. The average distance between the inferior opening of the NLD and anterior end of the inferior turbinate was 14.8 mm. The mean A-P diameter of superior opening of NLD was about 3 mm. The average length and width of nasolacrimal sac at its center was 6.95 and 3.24 mm respectively. Conclusion Detailed anatomical knowledge of the NLD is of great importance for safe and successful endonasal surgery. The present study attempts to provide useful surgical guidelines by using anatomic and positional relationships between the NLD and the major surrounding landmarks. How to cite this article Sahni SS, Goyal R, Gupta T, Gupta AK. Surgical Anatomy of Nasolacrimal Duct and Sac in Human Cadavers. Clin Rhinol An Int J 2014;7(3):91-95.

scholarly journals Measurement of acetabular wall indices: comparison between CT and plain radiography

2021 ◽  
Author(s):  
Jaron Nazaroff ◽  
Bryan Mark ◽  
James Learned ◽  
Dean Wang
Keyword(s):  
Clinical Decision Making ◽  
Posterior Wall ◽  
Clinical Decision ◽  
Anterior Wall ◽  
Concordance Correlation ◽  
Ct Measurements ◽  
Axial Ct ◽  
The Mean ◽  
Mean Differences ◽  
Acetabular Wall

Abstract The purpose of this study was to compare measurements of anterior wall index (AWI) and posterior wall index (PWI) on computed tomography (CT) to those on radiographs (XR). A consecutive cohort of 33 patients (45 hips total) being evaluated for hip pain with both XR and CT was examined. Preoperative measurements of AWI and PWI were performed utilizing supine anteroposterior pelvic XR and coronal and swiss axial CT scans by two independent raters. Mean differences between XR and CT measurements were compared, and agreement between measurements was assessed using the concordance correlation coefficient (rc) and Bland–Altman analysis. A total of 39 hips in 28 patients were analyzed. The mean patient age was 31.1 ± 9.0 years, and 50% were female. Mean AWI and PWI on XR was 0.50 ± 0.14 and 0.91 ± 0.12, respectively. Measured values of AWI were consistently larger (0.08 ± 0.10, P &lt; 0.01) on XR compared with both coronal and swiss axial CT, with moderate agreement between XR and CT measurements (rc = 0.68–0.70). Measured values of PWI were consistently smaller (0.15 ± 0.12, P &lt; 0.05) on XR compared with both coronal and swiss axial CT, with poor agreement between XR and CT measurements (rc = 0.37–0.45). Measured values of acetabular wall indices on XR were consistently larger for AWI and smaller for PWI relative to CT. Agreement between XR and CT measures of the indices were moderate to poor. This highlights the need for standardization of XR- and CT-based measurements to improve assessment of acetabular coverage and subsequent clinical decision-making.

scholarly journals Endoscopic dacryocystorhinostomy to treat congenital nasolacrimal canal dysplasia: A retrospective analysis in 40 children

2019 ◽  
Author(s):  
Yan-hui Cui ◽  
Cheng-yue Zhang ◽  
Wen Liu ◽  
Qian Wu ◽  
Gang Yu ◽  
...  
Keyword(s):  
Middle Turbinate ◽  
Nasolacrimal Duct ◽  
Cure Rate ◽  
Improvement Rate ◽  
Congenital Nasolacrimal Duct Obstruction ◽  
Endoscopic Dacryocystorhinostomy ◽  
Nasolacrimal Duct Stenosis ◽  
Low Incidence ◽  
Duct Stenosis

Abstract Purpose: To investigate the therapeutic effectiveness and safety of endoscopic dacryocystorhinostomy (EN-DCR) to treat congenital nasolacrimal canal dysplasia (CNCD). Methods: Forty children (50 eyes) with congenital nasolacrimal duct obstruction (CNLDO) and lacrimal bony dysplasia, including 8 with bony atresia (10 eyes) and 32 with bony stenosis (40 eyes), were recruited in this retrospective study. Standardized EN-DCR was performed in all cases. The post-operative observations included relief of symptoms, fluorescein dye disappearance test (FDDT), syringing of lacrimal passages and anastomotic patency under nasal endoscopy. Patients were followed up for 8-18 months. Results: The standardized EN-DCR surgery had a success (cure and improvement) rate of 100%, including a cure rate of 82% and an improvement rate of 18%. The cure rate of 40 bony nasolacrimal duct stenosis was 82.5% and 10 bony nasolacrimal duct atresia was 80%. Statistical analysis showed that nether the receipt of other treatments before surgery nor the type of bony nasolacrimal duct dysplasia affected the cure rate. No significant complications were observed during the post-operative follow-up, except for four cases (4 eyes) that suffered middle turbinate and nasal mucosal adhesion and two cases with sinusitis. Conclusions: CNCD is a type of CNLDO that does not respond to conservative and conventional treatment. EN-DCR provides a safe and effective treatment for children with CNCD. It has a high success rate with a low incidence of complications.

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