The Relationships Between the Nasolacrimal Duct and the Anterior Wall of the Maxillary Sinus

Maxillary Sinus Anatomy and Physiology

This study summaries the anatomy, including neurovascular anatomy, and physiology of the maxillary sinus. As the maxillary sinus is intimately related to the maxillary dentition, the maxillary sinus is the first paranasal sinus to become involved in infections of dental origin. Not only are these infections often very symptomatic but also spread to neighboring paranasal sinuses and extrasinus tissues such as the skin and the orbit.

Assessment of the prelacrimal recess in different maxillary sinus pneumatizations in relation to endoscopic prelacrimal recess approaches: a computed tomography study

PURPOSE

To assist in planning before the endoscopic prelacrimal recess (PLR) approach, we aimed to investigate the relationship between morphometry and variations of PLR in maxillary sinus (MS) pneumatizations.

METHODS

Retrospective analysis of the paranasal sinus computed tomography images of 150 patients was conducted to determine the pneumatization patterns of the MS, PLR variations, and the applicability of the PLR approach. The results were compared based on lateralization, gender, and age groups.

RESULTS

The PLR_width, the anteroposterior diameter of the nasolacrimal duct (NLD), the vertical and horizontal diameters of the MS were the highest in hyperplasic MS, and decreased significantly with increasing age (p = 0.005, p = 0.017, p = 0.000), respectively. Most of the morphometric measurements were higher in hyperplasic MS, while the medial wall thickness of PLR was higher in hypoplasic MS. The PLR_width for feasibility of the PLR approach were Type I (48%) in hypoplasic MS and Type III (80%) in hyperplasic MS (p < 0.001), respectively. The PLR medial wall thickness was higher in Type I, while the piriform aperture angle (PAA), MS volume, length, and slope of the NLD were higher in Type III PLR_width (p = 0.000), respectively. The highest anterior and separation-type variations of the PLR were observed in hyperplasic MS, whereas 31.0% of hypoplasic MS had no PLR (p < 0.001).

CONCLUSION

This study revealed that PLR_width and PAA were the highest in hyperplasic MS, which allows the endoscopic PLR approach to be performed more easily. For safer and uncomplicated surgery, surgeon should be aware of the PLR anatomy in different MS pneumatization patterns.

Effect of anterior maxillary wall shape on ease of prelacrimal recess approach among Asians and Westerners

PURPOSE

Endoscopic sinus surgery has been widely used in the treatment of most maxillary diseases, although the inability to access lesions in the anterior and inferior maxillary sinus walls is a major disadvantage. In few cases, the prelacrimal recess (PLR) approach can be used, which secures an overall view within the maxillary sinus. The distance between the anterior maxillary wall and lacrimal duct is related to the ease of the PLR approach. First we measured the distance between the anterior maxillary wall and lacrimal duct using anatomical image analysis to classify the types and then evaluated whether anatomical factors were related to the results.

METHODS

Both sides of the sinuses were evaluated in 272 participants (544 sides). After marking a tangent line (line 1 [L1]) through the posterior surface of the anterior maxillary sinus wall and a parallel line (line 2 [L2]) to the anterior surface of the lacrimal duct, the vertical distance between L1 and L2 was measured. Vertical distances of < 3 mm, 3-7 mm, and > 7 mm were classified as PLR approach types I, II, and III, respectively. In the axial plane image, line 3 (L3) (a horizontal line starting from the inner anterior maxillary sinus wall) was drawn and the angle with L1 (L1-L3A) was measured.

RESULTS

The proportions of types I, II, and III were 23.2% (126), 55.0% (299), and 21.8% (119), respectively. The mean L1-L3As for types I, II, and III were 12.87 ± 4.92°, 11.20 ± 5.08°, and 10.40 ± 4.47°, respectively, showing a significant difference in mean values (p < 0.001). The L1-L3A and vertical distance between L1 and L2 showed a significant negative correlation (r = - 0.201, p < 0.001).

CONCLUSIONS

We observed a correlation between the distance from the anterior maxillary wall to the lacrimal duct and L1-L3A. The L1-L3A indicates the degree of curvature of the anterior maxillary wall; therefore, the smaller the L1-L3A, the easier it may be to access the PLR.

Lacrimal Sac Anterior Border-Maxillary Line Distance: Effect on Endoscopic Dacryocystorhinostomy (EDCR) Surgery Results and NLDO-SS Questionnaire

This study aimed to investigate the effect of the maxillary line (ML)-lacrimal sac anterior border (LSA) distance on the results of endoscopic dacryocystorhinostomy (EDCR) operation. The study was designed retrospectively. The distance between LSA and ML was measured from preoperative paranasal sinus computed tomography (PNSCT) images. Nasolacrimal duct obstruction symptom score (NLDO-SS) was calculated before and after surgery. The endoscopically proven of the transition of the 2% fluorescein drop instilled into the eye to the nasal passage accepted as a surgical success. 47 patients included in the study and eight of them underwent bilateral EDCR. The average age of the patients was 50.3 ± 14.8. The LSA-ML distance was 4.2 ± 1.0 mm in all patients. The duration of surgery was found as 38.1 ± 6.1 min for each side. The preoperative NLDO-SS mean was 54.9 ± 11.7 and 22.2 ± 12.1 postoperatively (p = 0.000, CI = 28.9-36.2). Six patients (11%) required revision surgery. A statistically significant high positive correlation was found between duration of surgery and LSA-ML distance (p = 0.000, r = 0.840). There was a significant negative correlation between the duration of surgery and postoperative NLDO-SS (p = 0.041, r = -0.276). The LSA-ML distance calculated in this study was found to be significantly associated with the decrease in the duration of surgery and the NLDO-SS score obtained after surgery. However, more valid results can be obtained if similar studies are carried out in larger samples containing a sufficient number of revision cases.

Anterior maxillary wall and lacrimal duct relationship in pediatric patients - CT analysis for the feasibility of the prelacrimal recess approach

OBJECTIVE

The purpose of the current study is to determine the age-related feasibility rate of the intranasal endoscopic prelacrimal recess approach (PLRA) in pediatric patients.

METHODS

Computed tomography (CT) images of 379 patients under 18 years old were analyzed retrospectively. The anteroposterior dimensions of the medial bony wall of the prelacrimal recess (PLR) were measured on 758 sides. The feasibility of the PLRA was evaluated according to the criteria of Simmen et al., for each age and three age groups based on trends in the change of the width of the PLR.

RESULTS

Less than half (45.9%) of pediatric maxillary sinuses (MS) were found to have the favorable anatomy (width of PLR >3 mm) to perform the PLRA. The cut-off value for age regarding the feasibility of the PLRA was nine years old. Following an evaluation of the groups, the proportions of the MS with favorable anatomy for the PLRA were 5.7% in Group I (age 0-4 years), 33.3% in Group II (age 5-8 years), and 55.1% in Group III (age 9-17 years). In group III, the feasibility rate for the PLRA was greater in boys (62.1%) than in girls (48.3%). No difference in the feasibility rate was found between the right and left sides.

CONCLUSION

The overall feasibility rate for the PLRA in pediatric patients under 18 years of age is 46%. In patients aged 9-17 years, the feasibility rate for the PLRA is >50%.

Gender-specific differences in feasibility of pre-lacrimal window approach

The feasibility and surgical effort of a pre-lacrimal window approach (PLWA) depends on the width of the bony window anterior to the nasolacrimal duct. This study aimed to investigate gender-specific differences in feasibility of PLWA. A consecutive series of paranasal computed tomography scans from 50 females (n = 100) and 50 males (n = 100) were retrospectively analyzed. The primary outcome measure was the antero-posterior length of the bony pre-lacrimal window (BPLWA). The secondary outcome measure was the distribution of Simmen’s PLWA feasibility types (major, moderate and minor surgical effort). On average, males had a 1.5 mm (95% CI 0.8–2.2) significantly higher BPLW length in comparison to females [t(198) = 4.4, p < 0.0001]. The requirement of major surgical effort occurred 29% more frequently in females [χ²(1) = 17.7, p < 0.0001], whereas the necessity of moderate surgical effort was 21% more prevalent in males [χ²(1) = 8.8, p = 0.003]. The need of only minor surgical effort was twice as high in males compared to females [χ²(1) = 3, p = 0.081]. Our data indicates that females require more significant surgical effort during a PLWA to gain access to the maxillary sinus. These results are highly informative as a high amount of bone removal and nasolacrimal duct dislocation are associated with a higher likelihood of complications.

Factors associated with epiphora following orbital-sparing maxillectomy via modified Weber-Ferguson incision with lower blepharoplasty

PURPOSE

The aims of the study were to estimate the frequency of epiphora and to identify factors associated with epiphora after orbital-sparing maxillectomy via modified Weber-Ferguson incision with lower blepharoplasty (OSOSM-MWFILB).

METHODS

We performed a retrospective cohort study enrolling a sample derived from the patient population undergoing OSM-MWFILB over a 7-year period. The predictor variables were grouped into demographic, related health status, anatomic, tumor-specific, and therapeutic categories. The primary outcome variable was the presence of postmaxillectomy epiphora (PME). Descriptive, univariate, and multivariate regression mixed-effect models were computed.

RESULTS

The study sample was composed of 134 patients (46.3% females; 71.6% squamous cell carcinomas) with a mean age of 64.7 ± 12.2 years. There were 23 (17.2%) PME events, which were significantly associated with eight variables: male gender, poor general health (ASA III-IV), large vertical defect (Brown and Shaw's class III-IV), squamous cell carcinoma tumor type, big tumor size (T3-4), cervical lymph node metastasis (N1-2), long operating time > 3 h, and adjuvant radio(chemo)therapy in both univariate mixed regression and multivariate Cox hazards analyses. Healing of PME in irradiated patients was significantly delayed.

CONCLUSIONS

Ophthalmologic consequences in patients undergoing OSM-MWFILB require particular attention, especially in case of advanced tumors, multiple comorbidities, or long surgery with postoperative radio(chemo)therapy. This emphasizes the importance of appropriate cooperation between the surgeons and ophthalmic colleagues.

Prevalence of the prelacrimal recess in maxillary sinus and its medial bony wall dimensions

OBJECTIVE

To investigate the occurrence rate of the prelacrimal recess (PLR) and its medial bony wall dimensions based on the radiological analysis to help surgeons enhance the understanding of anatomic structures for the endoscopic prelacrimal recess approach.

METHODS

Cone-beam computed tomography images of 255 patients were evaluated retrospectively. The prevalence of the PLR in maxillary sinus was investigated and the thickness of its medial bony wall was measured and statistically assessed. Meanwhile, the width of the PLR was measured. The correlation between the width of the PLR and its medial bony wall thickness was assessed. The data were compared between the left side and right side, male and female.

RESULTS

The PLR was present in 82.5% of the maxillary sinus, with no significant differences between the left and right sides, as well as different gender groups. The mean thickness of the medial bony wall of the PLR was 2.84 ± 1.41 mm, without statistical difference between the left and right sides but significantly larger in males than in females. The mean width of the PLR was 4.62 ± 1.74 mm and it had a significant negative correlation with the thickness of the medial bony wall of the PLR.

CONCLUSION

A large individual variation exists in the anatomy of PLR, including its prevalence and dimensions of its medial bony wall. When considering the intranasal endoscopic prelacrimal recess approach, the surgeons should carefully evaluate the anatomical structure of the PLR preoperatively so as to minimize the risks of surgical complications.

[Surgical anatomy of the maxillary sinus]

BACKGROUND

Improved understanding of the microanatomy of the paranasal sinuses, including its individual variations, makes a substantial contribution to current progress in endonasal endoscopic microsurgery. Microanatomy of the sinuses is an active field of present scientific investitations.

MATERIALS AND METHODS

A comprehensive review on microanatomy of the maxillary sinus is presented from the perspective of contemporary endonasal endoscopic microsurgery.

RESULTS

The range of variation of the individual microanatomy of all sections of the maxillary sinus is presented, in particular to minimize secondary sugical tissue trauma, to avoid complications (e.g. on orbital tissues) and as a basis for the prelacrimal access to the maxillary sinus.

CONCLUSION

Improved understanding of the range of microanatomical variations reduced the burden on the patient while opimizing the effectiveness of the necessary surgical manipulations.

Assesment of Prelacrimal Recess in Patients With Maxillary Sinus Hypoplasia Using Cone Beam Computed Tomography

BACKGROUND

The prelacrimal recess approach, is frequently preferred in creating a minimally invasive surgical corridors.

OBJECTIVE

The aim of this study was to evaluate the Prelacrimal recess (PLR) anatomy using Cone Beam Computed Tomography in patients with Maxillary Sinus Hypoplasia.

METHODS

The paranasal Cone Beam Computed Tomography series of 84 adults were analyzed retrospectively. The antero-posterior and mesio-distal widths of the PLR and the antero-posterior width of the naso-lacrimal duct were measured. The patients were divided into three groups according to the antero-posterior width of PLR to evaluate the feasibility of prelacrimal recess approach as Type 1 (0-3 mm), Type 2 (>3-7 mm) and Type 3 (>7 mm).

RESULTS

The mean antero-posterior width of PLR was 3.11 ± 1.49mm in the patients and 4.77 ± 1.76 mm in the controls. The mean mesio-distal width of PLR was 7.64 ± 1.49 mm in the patients and 3.17 ± 2.05 mm in the controls. The mean antero-posterior width of naso-lacrimal duct was 9.58 ± 2.80 mm in the patients and 9.46 ± 2.42 mm in the controls.

CONCLUSIONS

The width of the antero-posterior PLR in patients with Maxillary Sinus Hypoplasia was found to be significantly lower in comparison to individuals with normal maxillary sinuses in the measurements performed on paranasal Cone Beam Computed Tomography scans. Hence, while planning a Functional Endoscopic Sinus Surgery with prelacrimal recess approach for maxillary sinus, the anatomical structure of the naso-sinusoidal region should be carefully analyzed, and individual anatomical variations such as Maxillary Sinus Hypoplasia should not be ignored.

Assessment of the prelacrimal recess in maxillary sinus in different sex and age groups using cone beam computed tomography (CBCT)

BACKGROUND

The intranasal endoscopic prelacrimal recess approach (PLRA) to the maxillary sinus (MS) has been reported to treat many MS and skull base diseases. However, previous studies revealed that the width of the prelacrimal recess (PLR) shows a large individual variation. The purpose of this study was to ascertain the prevalence of the PLR in MS according to gender and age.

METHODS

A series of 701 maxillofacial cone beam computed tomography (CBCT) scans from adult patients were analyzed retrospectively. Patients were divided into five age groups (18-24 years, 25-34 years, 35-44 years, 45-54 years, and ≥ 55 years) and by sex. The frequencies of occurrence of the PLR in the MS were calculated and compared.

RESULTS

According to the findings obtained from our study, PLR was present in 81.5% of maxillary sinuses. No differences were found when the data distributions of right and left sides were compared. For individuals, the right and left sides were not always symmetrical. The probability of PLR was lesser among women than among men, but this differences was not significant. Another finding of our study was that the percentage of PLR decreased with increasing age among patients aged < 55 years, however, increased again among patients aged ≥ 55 years.

CONCLUSION

The anatomy of PLR varies among individuals. Careful analysis of individual anatomical structure characteristic is recommended when considering intranasal endoscopic PLRA to the MS. Besides, the age variation of PLR should be considered in order to avoid complications.