Relationship of the anterior ethmoid sinus to the lacrimal sac: a computed tomography study

Remor, Beatriz Luiza de Costa; Filho, Leonardo Lopes Balsalobre; Bison, Simone Haber Duellberg Von Faber; Nogueira, Maria Helena Salgado Delamain Pupo; Meurer, Ana Taíse de Oliveira; Bastos, David Caetano; Stamm, Aldo Eden Cassol

doi:10.1016/j.bjorl.2022.02.002

Cited by 2 publications

(3 citation statements)

References 20 publications

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“…Fourth, we did not examine the position of the agger nasi cell that is an important anatomical structure during endoscopic DCR. A previous study showed that half of the patients had the agger nasi cell located medial to the lacrimal sac 22 . In such cases, this cell should be opened before the osteotomy.…”

Section: Discussionmentioning

confidence: 97%

Positional relationship between lacrimal sac and skull base: implication of risk of cerebrospinal fluid leakage during dacryocystorhinostomy

Kono

Vaidya

Naito

et al. 2022

Sci Rep

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Cerebrospinal fluid (CSF) leakage is a rare but severe complication during dacryocystorhinostomy (DCR). Understanding the details of the anatomy of the lacrimal drainage system and skull base is essential to avoid this complication. We examined the positional relationship between the lacrimal sac and skull base using 16 cadavers (22 sides) and using computed tomographic images taken in 81 patients (81 sides). Consequently, the frontal sinus intervened between the lacrimal sac and skull base in 81.8–90.1% of cases. The lacrimal sac fundus and posterior lacrimal crest were far from the skull base/cribriform plate, and the skull base above the lacrimal sac was considerably thick. These results indicate that the risk of skull base injury and consequent CSF leakage during DCR is extremely low. However, surgeons should be cautious of this complication by indirect injury due to a twisting movement of a bone rongeur applied to the maxillary bone during creation of a bony window in patients with no interposition of the frontal and ethmoid sinuses between the lacrimal sac and skull base.

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Section: Discussionmentioning

confidence: 97%

Positional relationship between lacrimal sac and skull base: implication of risk of cerebrospinal fluid leakage during dacryocystorhinostomy

Kono

Vaidya

Naito

et al. 2022

Sci Rep

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“…[6-8] It is critical that surgeons who intend to perform endoscopic DCR understand the anatomy of the lateral nasal wall and its landmarks -such as the anterior region of the uncinate process, the axilla of the middle turbinate, the agger nasi cell, and the "lacrimal bulge" -to ensure proper identi cation and opening of the LS. [6, [9][10][11] The LS has a close relationship with the agger nasi; indeed, this ethmoidal air cell makes up the posteromedial boundary of the LS. [9,12] In a study published by Remor et al regarding this association, CT evaluation of the relationship between the AN and the LS revealed that, in almost 60% of cases, the most anterior ethmoidal cell is located medial to the LS; its anterior opening can thus be inferred to constitute an important step for proper LS exposure and postoperative control.…”

Section: Introductionmentioning

confidence: 99%

“…[9,12] In a study published by Remor et al regarding this association, CT evaluation of the relationship between the AN and the LS revealed that, in almost 60% of cases, the most anterior ethmoidal cell is located medial to the LS; its anterior opening can thus be inferred to constitute an important step for proper LS exposure and postoperative control. [11] The aim of the present study is to describe a new technique for endoscopic dacryocystorhinostomy that uses the agger nasi cell as a reference, showing the surgical results.…”

Section: Introductionmentioning

confidence: 99%

The Agger nasi DCR: a new technique for endoscopic dacryocystorhinostomy

Balsalobre,

Dutra,

Nogueira

et al. 2024

Preprint

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Purpose Endoscopic dacryocystorhinostomy (DCR) is the gold-standard procedure for the treatment of nasolacrimal duct obstruction, aiming to open the lacrimal sac directly into the nasal cavity and thus re-establish drainage of the tear pathways. The present study proposes a new surgical technique that relates the agger nasi cell (AN) to the lacrimal sac and advocated for its systematic opening. Methods We analyzed 36 patients who underwent DCR using the AN as a key landmark over a 2-year period. The criteria for assessment of surgical success were patency of the ostium that communicates the lacrimal sac with the nasal cavity and absence of significant epiphora according to the Munk scale. Results Patency of the drainage ostium was observed in the late postoperative period in 100% of cases. Epiphora were absent in 86.48% of those cases followed for at least 6 months after surgery. Conclusion Agger nasi dacryocystorhinostomy (AN-DCR) involves opening the AN as a landmark for wide and complete exposure of the lacrimal sac. This approach is a safe and highly effective method that yields good postoperative outcomes.

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Relationship of the anterior ethmoid sinus to the lacrimal sac: a computed tomography study

Cited by 2 publications

References 20 publications

Positional relationship between lacrimal sac and skull base: implication of risk of cerebrospinal fluid leakage during dacryocystorhinostomy

Positional relationship between lacrimal sac and skull base: implication of risk of cerebrospinal fluid leakage during dacryocystorhinostomy

The Agger nasi DCR: a new technique for endoscopic dacryocystorhinostomy

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