To study the affect of anatomical variance of lacrimal sac fossa on dacryocystorhinostomies (DCR) performed by the traditional external (EX-DCR) approach or an endoscopic (EN-DCR) endonasal approach. A total of 292 consecutive cases with primary nasolacrimal obstruction underwent DCR surgery. Orbital computed tomography scan was used to measure lacrimal sac fossa and other related structures and Lac-Q questionnaire was used to compare surgery result. Maxillary portion of lacrimal sac fossa is thicker in failed surgery group than successful surgery group (P<0.05). Lateral nasal structures (uncinate process, operculum of the middle turbinate, agger nasi) are dominantly adjusting to lacrimal sac fossa in failed surgery group (P<0.05). Patients who underwent EX-DCR has a 6.0-point and EN-DCR group 11.0-point improvement (P<0.016) in Lac-Q questionnaire. Patients who have a thick frontal process of the maxilla and uncinate process, operculum of the middle turbinate, ethmoid cells adjusting to lacrimal fossa are prone to have recurrence of nasolacrimal duct obstruction after DCR surgery. The EN-DCR and the EX-DCR approach have an equivalent surgical success rate but improvement in quality of life by using the Lac-Q questionnaire is greater in the endoscopic group when compared with the external.
Objectives: To compare the morphometric differences of the bony nasolacrimal canal in unilateral primary acquired nasolacrimal duct obstruction (PANDO) patients between PANDO and non-PANDO sides and the control group in the Mongolian population. Methods: A hospital-based, retrospective case-control design was used for this study. A total of 584 participants were grouped into PANDO patients and the control group. Morphometry of the bony nasolacrimal canal was measured by CT scan. Results: The bony nasolacrimal canal’s minimum transverse diameter was 3.67 ± 1.96 mm on the PANDO side, 3.98 ± 2.01 mm on the non - PANDO side and 4.03 ± 1.12 mm for the control group (p > 0.05). The distal bony nasolacrimal canal transverse diameter was 4.39 ± 1.21 mm for the PANDO side, 4.33 ± 1.32 mm on the non-PANDO side and 5.11 ± 1.25 mm for the control groups (p < 0.05). The bony nasolacrimal canal entrance transverse diameter was 4.36 ± 1.59 mm on the PANDO side, 4.43 ± 1.83 mm on the non-PANDO side and 4.69 ± 1.61 mm in the control group (p < 0.05). Conclusion: Narrower bony nasolacrimal canal morphology may cause a tendency for PANDO development. We identified a narrow distal bony nasolacrimal transverse diameter for both the PANDO and non-PANDO sides of unilateral PANDO patients compared with the control group.
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