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

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.

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%.