Dacryocystorhinostomy Utilizing an Anterior Lacrimal Sac Flap to Periosteum Technique

Dacryocystorhinostomy is used in the effective treatment of epiphora secondary to obstruction of the lacrimal drainage system. Common causes of obstruction include canalicular disruption, lacrimal sac fibrosis, and external and internal nasal trauma. Most techniques of dacryocystorhinostomy attempt to suture the lacrimal sac mucosa to the nasal mucosa. At best this is technically difficult, and the mucosa frequently tears. A technique is presented using an anteriorly based lacrimal sac pedicle flap sutured to the periosteum of the anterior lacrimal crest. The sutured flap is quite strong, and the procedure is technically simpler than others. A brief description of the causes of lacrimal obstruction is given. The Jones primary and secondary dye tests for lacrimal system patency are reviewed.

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The Relationship of Lateral Osteotomies in Rhinoplasty to the Lacrimal Drainage System

Otolaryngology ◽

10.1177/019459988609400319 ◽

1986 ◽

Vol 94 (3) ◽

pp. 362-367 ◽

Cited By ~ 17

Author(s):

J. Regan Thomas ◽

Nancy Griner

Keyword(s):

Drainage System ◽

Osteotomy Site ◽

Lacrimal Sac ◽

Lacrimal Duct ◽

Lacrimal Drainage System ◽

Lacrimal System ◽

Resident Surgeon ◽

Relationship Of ◽

The Relationship ◽

Lacrimal Drainage

Damage to the lacrimal drainage system is a potentially complicating factor in rhinoplasty utilizing lateral osteotomies. The authors present data from osteotomies performed on a series of fresh cadavers. Following completion of the osteotomies, the lacrimal sac and nasal lacrimal ducts were Identified and cannulated. Soft tissue was dissected to demonstrate the osteotomy site. The specimen was inspected to delineate involvement (if any) of the lacrimal duct or sac. The proximity of the osteotomy site to the lacrimal drainage apparatus components was measured in each specimen. Various parameters were observed, including the effect of curved vs. straight osteotomes, guarded vs. unguarded osteotomes, and the effect of various widths of osteotomes. Likewise, the degree of risk to the lacrimal system was evaluated, and the technique of the novice and resident surgeon was compared to that of the experienced rhinoplastic surgeon. A low, curved osteotomy, performed with a sharp osteotome without subperiosteal tunnels, provides the safest maneuver. Lateral osteotomies, properly performed, prove to be an unusual cause of lacrimal drainage dysfunction.

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In Vivo and Cadaver Studies of the Canalicular/Lacrimal Sac Mucosal Folds

Journal of Ophthalmology ◽

10.1155/2016/3453908 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Yongsheng You ◽

Jing Cao ◽

Xiaogang Zhang ◽

Wencan Wu ◽

Tianlin Xiao ◽

...

Keyword(s):

Drainage System ◽

Lacrimal Sac ◽

Functional Roles ◽

Chronic Dacryocystitis ◽

Common Canaliculus ◽

Cadaver Studies ◽

Mucosal Folds ◽

Mucosal Fold ◽

Lacrimal Drainage

Purpose.The study aimed to investigate canalicular/lacrimal sac mucosal folds (CLS-MFs) in vivo and in cadavers in order to explore their functional roles in the lacrimal drainage system.Method.The observations of CLS-MFs in vivo were performed on 16 patients with chronic dacryocystitis after undergoing an endonasal endoscopic dacryocystorhinostomy (EE-DCR). The lacrimal sacs and common canaliculi of 19 adult cadavers were dissected. The opening/closing of an orifice and mucosal fold was recorded. All of the specimens were subjected to a histological examination.Results.The upper and lower lacrimal canaliculi in all of the samples united to form a common canaliculus that opened to the lacrimal sac. CLS-MFs were observed in 10 of the 16 patients (62.5%) and 9 of the 19 cadavers (47.4%). The orifices or mucosal folds could be opened or closed when related muscles contracted or relaxed. Histological sections showed a mucosal fold at one side of an orifice.Conclusion.Common canaliculus is the most common type that the canaliculus opens to lacrimal sac. CLS-MFs exist in a certain ratio that can be opened/closed with the movement of the orifices. They may be involved in the drainage of tears or the pathogenesis of acute dacryocystitis or lacrimal sac mucocele.

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Evaluation of the results endonasal dacrocystorhinostomy in patients with DCR

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20170079 ◽

2017 ◽

Vol 3 (2) ◽

pp. 184

Author(s):

Mukund Vaghela ◽

Alpesh Patel ◽

Vaibhav Patel ◽

Ankur Dhanani

Keyword(s):

Postoperative Complications ◽

Lacrimal Sac ◽

Endoscopic Endonasal ◽

Lacrimal System ◽

Lacrimal Drainage

Background: Dacrocystitis refers to a series of clinical entities characterized by inflammation of lacrimal sac which leads to obstruction at the level of drainage of lacrimal system. Owing to the initial encouraging results and simplicity of the operation, it is decided that all symptomatic patients with lacrimal drainage obstruction would be treated initially by endoscopic endonasal dacrocystorhinostomy method, irrespective of the level of obstruction. Methods: A total 50 patients were included in the study over a period of 3-4 months. They were subjected to endonasal dacrocystorhinostomy and were evaluated for postoperative complications. Results: Very few complications were seen postoperatively suggesting that this newer technique may be useful. Conclusions: Endonasal dacrocystorhinostomy may prove better in coming years.

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Lacrimal drainage anomalies in Tessier cleft 3 with unilateral anophthalmos

European Journal of Ophthalmology ◽

10.1177/1120672119891475 ◽

2019 ◽

pp. 112067211989147

Author(s):

Swati Singh ◽

Abhimanyu Sharma ◽

Vikas Mittal ◽

Mohammad Javed Ali

Keyword(s):

Drainage System ◽

Nasolacrimal Duct ◽

Anatomical Location ◽

Lacrimal Sac ◽

Duct Obstruction ◽

Lacrimal Drainage System ◽

Computed Tomographic ◽

The Right ◽

Current Report ◽

Lacrimal Drainage

Bilateral Tessier cleft types 3 and 4 are rare and commonly involve the lacrimal drainage system owing to their anatomical location. Such clefts commonly present with associated ocular anomalies and include colobomatous eyelids, hypertelorism, microphthalmia, punctal or canalicular agenesis, and nasolacrimal duct obstruction or exstrophy. The current report presents an 18-month-old baby with bilateral Tessier cleft 3 with a unilateral anophthalmos, symmetrical eyelid colobomas, and lacrimal drainage anomalies. The lacrimal anomalies noted include small lacrimal sac with inferior canaliculus on the right side and upper and lower punctal and canalicular agenesis on the left side. Computed tomographic dacryocystography demonstrated unilateral lacrimal sac and bilateral maldevelopment of the bony nasolacrimal duct.

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Primary mucosa-associated lymphoid tissue (MALT) lymphoma of the lacrimal drainage system in two pediatric patients

European Journal of Ophthalmology ◽

10.1177/1120672119837085 ◽

2019 ◽

Vol 30 (3) ◽

pp. NP18-NP23 ◽

Cited By ~ 1

Author(s):

Ahmet Yucel Ucgul ◽

Bercin Tarlan ◽

Pınar Uyar Gocun ◽

Onur Konuk

Keyword(s):

Malt Lymphoma ◽

Lymphoid Tissue ◽

Histopathological Examination ◽

Drainage System ◽

Excisional Biopsy ◽

Lacrimal Sac ◽

Lacrimal Drainage System ◽

Non Hodgkin Lymphoma ◽

Tumoral Lesion ◽

Lacrimal Drainage

Primary non-Hodgkin lymphoma (NHL) of lacrimal drainage system (LDS) is quite rare in children, but it is important to expedite early diagnosis in an effort to alter possible life-threatening disease since they are usually misdiagnosed as chronic dacryocystitis. In the literature, there are few examples of tumors of LDS in children. The authors herein report two pediatric cases of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) originating from lacrimal sac in an attempt to increase the knowledge about the clinical course of NHL of LDS. Considerable care must be taken since tumors of lacrimal drainage can mimic dacryocystitis clinically and macroscopically. Two patients both attended with painless swelling in the left lacrimal sac region and epiphora of the left eye. Orbital magnetic resonance imaging showed a tumoral lesion in the left lacrimal sac region and histopathological examination of excisional biopsy specimen demonstrated MALT lymphoma in both patients. The treatment regimen comprises lacrimal sac excision within the tumor, canalicular dacryocystorhinostomy (DCR) with bicanalicular silicone intubation (BSI) combined with chemotherapy and regional radiotherapy in one case, whereas the second case received only radiotherapy after canalicular DCR with BSI. Both of them maintained clinical remission along follow-up.

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Nasal Cytology in Radiofrequency Turbinate Volume Reduction

ORL ◽

10.1159/000513629 ◽

2021 ◽

pp. 1-6

Author(s):

Giancarlo Pecorari ◽

Giuseppe Riva ◽

Claudia Bartoli ◽

Mattia Ravera ◽

Valeria Dell’Era ◽

...

Keyword(s):

Allergic Rhinitis ◽

Effective Treatment ◽

Nasal Obstruction ◽

Nasal Mucosa ◽

Inferior Turbinate ◽

Volume Reduction ◽

Nonallergic Rhinitis ◽

Turbinate Hypertrophy ◽

Nasal Cytology ◽

Rhinitis Medicamentosa

Introduction: Radiofrequency turbinate volume reduction (RFTVR) is an effective treatment of inferior turbinate hypertrophy. RFTVR can reduce epithelial cell alterations in nasal mucosa. The aim of this observational study was to evaluate the effects of RFTVR on nasal obstruction and cytology, stratifying for different types of rhinitis. Methods: Nasal cytology and subjective nasal obstruction were evaluated on 113 patients before RFTVR (T0) and after 3 months (T1). The patients were divided into groups on the basis of the underlying disease: allergic rhinitis, nonallergic rhinitis, rhinitis medicamentosa, and other diseases (e.g., hormonal-based turbinate hypertrophy). Results: Nasal cytology at T0 identified 42 patients with allergic rhinitis, 40 with nonallergic rhinitis, 19 with rhinitis medicamentosa, and 12 with other diseases. An improvement of nasal cytology at T1 was observed in 29.2% of cases. They mainly consisted of patients with nonallergic rhinitis with neutrophils, whose neutrophil infiltrate decreased. Only 2 cases (1.7%) showed a worsening of nasal cytology at T1. A statistically significant decrease in subjective nasal obstruction was observed for every group (p < 0.05). Higher differences of nasal obstruction between T0 and T1 were found in patients with rhinitis medicamentosa or other diseases. Conclusion: RFTVR represents a safe and effective treatment for turbinate hypertrophy of various etiology. It is not responsible for a worsening of inflammatory infiltrate of the nasal mucosa.

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