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Endoscopic dacryocystorhinostomy: anatomical approach.

V V Raut¹, M W Yung, B M Logan

¹Ipswich Hospital, Dept of ENT, United Kingdom.

Revue De Laryngologie - Otologie - Rhinologie

|June 24, 2000

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Endoscopic dacryocystorhinostomy (DCR) surgery can be simplified by identifying a thin "surgical window" of lacrimal bone. This anatomical landmark allows easier access to the lacrimal sac and duct, avoiding extensive bone removal.

Area of Science:

Anatomy
Otorhinolaryngology
Ophthalmology

Background:

Dacryocystorhinostomy (DCR) is surgery for nasolacrimal duct obstruction.
The endoscopic approach is increasingly favored over external methods.
Current endoscopic DCR requires drilling or chiseling the maxilla's frontal process to access the lacrimal sac and duct.

Purpose of the Study:

To identify anatomical landmarks for easier endoscopic dacryocystorhinostomy.
To determine the most accessible part of the lacrimal duct from within the nasal cavity.
To establish a less invasive surgical entry point for DCR.

Main Methods:

Study of 10 human cadaveric half-heads (5 male, 5 female).
Detailed anatomical dissection and measurement of the lacrimal apparatus within the nasal cavity.

Related Experiment Videos

Identification of bony structures overlying the lacrimal sac and duct.

Main Results:

The lacrimal sac and duct are covered by bone, primarily the frontal process of the maxilla.
A thin lacrimal bone (average 0.057 mm thickness) covers the posteromedial aspect of the lower sac and upper duct.
This thin bone forms a consistent "surgical window" (average 2.5 mm x 7.2 mm) anterior to the uncinate process in the middle meatus.

Conclusions:

The posteromedial lacrimal bone provides an accessible "surgical window" for endoscopic DCR.
This approach facilitates easier entry into the lacrimal duct.
It allows surgeons to bypass the need to drill or chisel the dense frontal process of the maxilla, simplifying the procedure.