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Diab MM, Ali MJ, Mohammed KK. Clinico-radiologic characteristics of lacrimal sac area swellings misdiagnosed as dacryocystocele or mucocele. Eur J Ophthalmol 2023; 33:152-160. [PMID: 35950228 DOI: 10.1177/11206721221120152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE Several non-lacrimal lesions can present with lacrimal sac area swelling mimicking a dacryocystocele or mucocele with a possibility of misdiagnosis. This study investigates the clinic-radiologic characteristics of the mimicking conditions compared to true lacrimal sac distension. DESIGN Retrospective, comparative, interventional case series. PARTICIPANTS Patients referred by primary care ophthalmologists between January 2015 and October 2021 with a misdiagnosis of dacryocystocele or lacrimal sac mucocele (n = 39) and an age-matched group of proven true lacrimal sac swelling (TLS group, n = 44). METHODS Data collected included demographics, presenting features, investigations, management, histopathology, and outcomes. Both groups were statistically compared for several clinical and radiological variables. RESULTS Final diagnoses in the mimicking group were skin/subcutaneous swellings (14/39, 35.9%), vascular malformations (10/39, 25.6%), inferomedial anterior orbital cysts (7/39, 17.9%), sino-orbital masses (5/39, 12.8%). Female gender (<0.001), epiphora (p = 0.001), and discharge (p < 0.001) were significantly more frequent in the TLS group. The mimicking group was more likely to be associated with a longer swelling duration (p < 0.001), a swelling extending beyond the lacrimal sac area (p <0.001), orbital signs (p <0.001), and periorbital abnormality. Non-patent lacrimal irrigation (p < 0.001) was significantly more frequent in the TLS group. On imaging, all swellings in the mimicking group were separate from the lacrimal pathway and 94.9% (37/39) extended beyond the lacrimal sac fossa. CONCLUSION Various cutaneous, subcutaneous, vascular, inferomedial orbital cystic, and sinonasal pathologies can present with lacrimal sac area swelling and mimic a TLS. A high index of suspicion, a thorough clinical evaluation and proper imaging are essential to avoid a misdiagnosis.
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Affiliation(s)
- Mostafa Mohammed Diab
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt
| | - Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L V Prasad Eye Institute, Hyderabad, India
| | - Khaled Kotb Mohammed
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt
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2
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Fleury V. Dynamics of early stages of nose morphogenesis. THE EUROPEAN PHYSICAL JOURNAL. E, SOFT MATTER 2022; 45:93. [PMID: 36401057 PMCID: PMC9674774 DOI: 10.1140/epje/s10189-022-00245-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
The formation of sensory organs is an important developmental and evolutionary question. In the context of regenerative medicine also, it is important to know as accurately as possible how sensory organs form. The formation of ears, eyes or nose stems presumably from tissue thickenings called placodes Graham and Shimeld (J Anat 222(1):32-40, 2013), Horie et al. (Nature 560:228-232, 2018) which become these organs after processes termed inductions. However, the origin of the placodes, the mechanism of induction and the overall face organization are not understood. Recently, it has been suggested that there is a physical principle to face organization. Indeed, it has been shown that there exists a pattern of rings and rays in the early blastula which defines the position of face landmarks, especially the ears and eyes Fleury et al. (Second order division in sectors as a prepattern for sensory organs in vertebrate development, 2021), Fleury and Abourachid (Eu Phys J E 45:31, 2022). Tensions in the sectors defined by the intersections of the said rings and rays create the actual face features. I report here that a similar situation exists for the nose. This explains the robustness of face formation in the chordates phylum. By studying nasal pit formation in the chicken embryo by time-lapse (T-L) video microscopy, I show that the nasal placode originates in a narrow sector deformed by tension forces following the biaxial pattern of rings and rays mentioned above. Cells align in the pattern and exert organized forces. Further contractions of the pattern contribute to inducing the nasal pit. The observation of the early pre-pattern of lines which locks the facial features explains readily a number of facts regarding sensory organs. Especially the existence of a lacrimal canal between the eye and the nose Lefevre and Freitag (Semin Ophthalmo l 27(5-6):175-86, 2012), or of a slit connecting the nose to the mouth, the correlation between nose, mouth and eye morphogenesis Dubourg et al. (J Rare Dis 2(8), 2007), the presence of shallow valleys on the nasal and optic vesicles, the medio-lateral asymmetry of nostrils with often a bent slit Liu et al. (PLoS ONE 12: e0181928, 2017), the uneven number of nostrils in many fish Cox (J R Soc Interf 5(23):575-593, 2008) and possibly the transition between agnatha and gnathostomes Gai and Zhu (Chinese Sci Bull 57(31), 2012): all appear under this light, geometrically straightforward. The nasal pit forms in a sector of tissue which was present on the blastodic (early embryonic stage), and which is projected onto the nasal vesicle during neurulation. The nasal pit forms along a hairpin of tissue. The top part of the hairpin forms the nares, and the bottom part a groove often visible in many animals.
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Affiliation(s)
- Vincent Fleury
- Laboratoire Matière et Systèmes Complexes, Université de Paris Cité/CNRS UMR 7057, 10 Rue Alice Domont et Léonie Duquet, 75013, Paris, France.
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3
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Vinciguerra A, Resti AG, Rampi A, Bussi M, Bandello F, Trimarchi M. Endoscopic and external dacryocystorhinostomy: A therapeutic proposal for distal acquired lacrimal obstructions. Eur J Ophthalmol 2022; 33:1287-1293. [PMID: 36254409 PMCID: PMC10152216 DOI: 10.1177/11206721221132746] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Endoscopic (END-DCR) and external dacryocystorhinostomies (EXT-DCR) are nowadays considered the gold standard techniques for non-oncologic distal acquired lacrimal disorders (DALO). However, no unanimous consensus has been achieved on which of these surgeries is the most suitable to the individual patient. Herein, we review the available literature of the last 30 years with the aim of defining a simple and reproduceable treatment algorithm to treat DALO. A search of PubMed, EMBASE, Scopus and Cochrane databases was last performed in December 2021 to examine evidence regarding the role of END-DCR and EXT-DCR in primary and revision surgeries. If considered primary surgeries, END-DCR should be preferred in case of intranasal comorbidities, given the possibility to directly visualize and treat potential intranasal pathologies. Conversely, EXT-DCR should be chosen in case of need/preference for local anesthesia, given the major historical experience and wider surgical field that helps to resolve intra-operatory complications (e.g., bleeding) in an uncollaborative patient. In the absence of the abovementioned conditions, the decision of one or other approach should be discussed with the patient. In recurrent cases, END-DCR should be considered the treatment of choice given the major likelihood to visualize the causes of primary failure and directly resolve it. In conclusion, END-DCR should be considered the treatment of choice in revision cases or in primary ones associated with intranasal pathologies, whereas EXT-DCR should be chosen if local anesthesia is needed. In the absence of these scenarios, it is still open to debate which of these two approaches should be used.
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Affiliation(s)
- Alessandro Vinciguerra
- Division of Head and Neck Department, Otorhinolaryngology Unit, 9372IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, 478583Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Giordano Resti
- Division of Head and Neck Department, Ophthalmology Unit, 9372IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Rampi
- Division of Head and Neck Department, Otorhinolaryngology Unit, 9372IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, 478583Vita-Salute San Raffaele University, Milan, Italy
| | - Mario Bussi
- Division of Head and Neck Department, Otorhinolaryngology Unit, 9372IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, 478583Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Bandello
- School of Medicine, 478583Vita-Salute San Raffaele University, Milan, Italy.,Division of Head and Neck Department, Ophthalmology Unit, 9372IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Trimarchi
- Division of Head and Neck Department, Otorhinolaryngology Unit, 9372IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, 478583Vita-Salute San Raffaele University, Milan, Italy
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4
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Mirshahvalad SA, Chavoshi M, Bahmani Kashkouli M, Fallahi B, Emami-Ardakani A, Manafi-Farid R. Diagnostic value of lacrimal scintigraphy in the evaluation of lacrimal drainage system obstruction: a systematic review and meta-analysis. Nucl Med Commun 2022; 43:860-868. [PMID: 35506272 DOI: 10.1097/mnm.0000000000001578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE A systematic review and meta-analysis to evaluate the diagnostic performance of lacrimal scintigraphy (LS) versus anatomical methods in the evaluation of the nasolacrimal duct obstruction (NLDO). MATERIALS AND METHODS A systematic search was performed using electronic bibliographic databases until the end of May 2021. Inclusion criteria: (a) used LS as a diagnostic method to evaluate NLDO; (b) used anatomical studies [including syringing, irrigation, probing, and dacryocystography (DCG)] as reference tests; and (c) provided adequate crude data. A hierarchical method was used to pool the sensitivity and specificity. The hierarchical summary receiver-operating characteristic model was performed. Additionally, the studies' heterogeneity and publication bias were analyzed. All analyses were conducted by the 'Midas' module of STATA 16. RESULTS Twelve articles (with 14 separate populations) were considered eligible to enter the meta-analysis. They were divided into two groups based on the reference standard method, called irrigation and DCG groups. In the irrigation group, the pooled sensitivity and specificity were 89% [95% confidence interval (CI), 72-96%] and 25% (95% CI, 8-56%), respectively. In DCG group, the pooled sensitivity and specificity were 97% (95% CI, 85-100%) and 27% (95% CI, 0.12-0.49), in turn. CONCLUSION LS is a sensitive modality to evaluate the anatomical obstruction of NLD. In contrast, it shows low pooled specificity compared with anatomical methods. Thus, LS can be used as the first noninvasive modality for the evaluation of epiphora. However, in case of any abnormality, confirmatory procedures are required.
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Affiliation(s)
- Seyed Ali Mirshahvalad
- Research Center for Nuclear Medicine, Dr. Shariati Hospital, Tehran University of Medical Sciences
| | - Mohammadreza Chavoshi
- Department of Radiology, Dr. Shariati Hospital, Tehran University of Medical Sciences
| | - Mohsen Bahmani Kashkouli
- Skull Base and Eye Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Babak Fallahi
- Research Center for Nuclear Medicine, Dr. Shariati Hospital, Tehran University of Medical Sciences
| | - Alireza Emami-Ardakani
- Research Center for Nuclear Medicine, Dr. Shariati Hospital, Tehran University of Medical Sciences
| | - Reyhaneh Manafi-Farid
- Research Center for Nuclear Medicine, Dr. Shariati Hospital, Tehran University of Medical Sciences
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5
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Ozturker C, Kaynak P. Epiphora and Dacryocystitis After Transcanalicular Laser-assisted Dacryocystorhinostomy due to an Undiagnosed Dacryolith. Ophthalmic Plast Reconstr Surg 2022; 38:e59-e62. [PMID: 34873124 DOI: 10.1097/iop.0000000000002102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 45-year-old female patient who had previously undergone endoscopic dacryocystorhinostomy (EN-DCR) at another surgical center was diagnosed with functional failure after DCR and underwent an uneventful transcanalicular laser-assisted DCR (TCL-DCR). After 5 months, the patient underwent endoscopic examination due to persistent epiphora and dacryocystitis attacks. Endonasal visualization revealed a large dacryolith that filled the ostium and sac and was removed en bloc mechanically with forceps. Carbonized material on the dacryolith's superior part indicated that it was perforated through-and-through by the laser beam during TCL-DCR. The patient's complaints were resolved completely following the removal of the dacryolith. The transcanalicular lacrimal procedures do not allow complete visualization of the contents of the lacrimal sac, and the laser beam can ablate even an undetected dacryolith and may result in unsuccessful DCR, although the surgical course may look completely uneventful.
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Affiliation(s)
- Can Ozturker
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Pelin Kaynak
- Ophthalmic Plastic and Reconstructive Surgery Division, Rufus Eye Microsurgery Center, Istanbul, Turkey
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6
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Trimarchi M, Vinciguerra A, Resti AG, Giordano L, Bussi M. Multidisciplinary approach to lacrimal system diseases. ACTA ACUST UNITED AC 2021; 41:S102-S107. [PMID: 34060525 PMCID: PMC8172105 DOI: 10.14639/0392-100x-suppl.1-41-2021-10] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/21/2021] [Indexed: 12/12/2022]
Abstract
Pathologies of the lacrimal drainage system range from benign to malignant lesions. However, independently of the etiological origin, the most common presenting symptom is represented by epiphora due to the dysfunction of the lacrimal system. Different diagnostic tools are now available, but for the most the first diagnostic approach is characterized by an ophthalmological visit, associated with nasal endoscopy, usually performed by an otolaryngologist. Frequently the diagnostic work-up is completed with a radiological exam (e.g. maxilla-facial CT or dacryocystography), whose role is still to be determined. Once a diagnosis has been made, different treatments are available in relation to the type of the disease, and commonly need close cooperation between an ENT and ophthalmic surgeon given the close anatomical structures involved. Taking into account all these aspects, the aim of this review is to highlight how a multidisciplinary approach to lacrimal pathologies is mandatory from diagnosis to treatment in order to offer the best clinical approach.
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Affiliation(s)
- Matteo Trimarchi
- Otorhinolaryngology Unit, Head and Neck Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Vinciguerra
- Otorhinolaryngology Unit, Head and Neck Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Giordano Resti
- Ophthalmologic Unit, Head and Neck Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Leone Giordano
- Otorhinolaryngology Unit, Head and Neck Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mario Bussi
- Otorhinolaryngology Unit, Head and Neck Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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7
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Bohman E, Berggren J, Bunke J, Albinsson J, Engelsberg K, Dahlstrand U, Hult J, Hasegawa H, Cinthio M, Sheikh R. Novel Evidence Concerning Lacrimal Sac Movement Using Ultra-High-Frequency Ultrasound Examinations of Lacrimal Drainage Systems. Ophthalmic Plast Reconstr Surg 2021; 37:334-340. [PMID: 33156146 DOI: 10.1097/iop.0000000000001865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Current hypothesis regarding the mechanism of active tear drainage is based on studies performed ex vivo or under nonphysiological conditions. Novel ultra-high-frequency ultrasound has the advantage of generating images with superior resolution, enabling measurements of low flow in small vessels, and the tracking of tissue motion in real time. The purpose of this study was to investigate the lacrimal drainage system and active drainage using this modality. METHODS The upper lacrimal drainage system was investigated with 40-70 MHz ultrasound in 22 eyes in 13 patients. Irrigation confirmed a lacrimal obstruction in 10 eyes. Motion tracking was used to map movement of the lateral lacrimal sac wall and to measure flow when possible. RESULTS The anatomy of the upper lacrimal drainage system was mapped in vivo, including the proximal canaliculi, which have not previously been imaged. The lacrimal sac lumen is slit shaped in its resting state but is distended when irrigated or if a nasolacrimal duct obstruction is present. Thus, the healthy lacrimal sac is not a cavity, and the medial retinaculum does not act against a stretched structure. Motion tracking visualized the "lacrimal pump," showing that the direction of motion of the lateral lacrimal sac wall is mainly in the sagittal plane during blinking. CONCLUSIONS Ultra-high-frequency ultrasound allows detailed physiological monitoring of the upper lacrimal drainage system in vivo. Our findings suggest that current theories of active tear drainage need to be reappraised.
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Affiliation(s)
- Elin Bohman
- Division of Ophthalmology and Vision, Department of Clinical Neuroscience, Karolinska Institutet, St. Erik Eye Hospital, Stockholm, Sweden
| | - Johanna Berggren
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Ophthalmology, Lund, Sweden
| | - Josefine Bunke
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Ophthalmology, Lund, Sweden
| | - John Albinsson
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Sweden
| | - Karl Engelsberg
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Ophthalmology, Lund, Sweden
| | - Ulf Dahlstrand
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Ophthalmology, Lund, Sweden
| | - Jenny Hult
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Ophthalmology, Lund, Sweden
| | - Hideyuki Hasegawa
- Faculty of Engineering, Academic Assembly, University of Toyama, Toyama, Japan
| | - Magnus Cinthio
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Sweden
| | - Rafi Sheikh
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Ophthalmology, Lund, Sweden
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8
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Vinciguerra A, Rampi A, Giordano Resti A, Barbieri D, Bussi M, Trimarchi M. Melanoma of the lacrimal drainage system: A systematic review. Head Neck 2021; 43:2240-2252. [PMID: 33843111 DOI: 10.1002/hed.26705] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/02/2021] [Accepted: 04/01/2021] [Indexed: 12/20/2022] Open
Abstract
Melanoma of the lacrimal drainage system (LDSM) is a rare and subtle condition that is frequently misdiagnosed. In the present work, we conducted a systematic review investigating the clinical features, management, and prognosis of LDSM. A structured search, according to PRISMA criteria, was performed in April 2020 and updated in February 2021 on Pubmed, EMBASE, Cochrane, and SCOPUS. The articles found underwent a double-reviewer selection and the main data were extracted. After complete screening, 30 articles reporting 38 cases were included. The time from the first symptom to medical contact ranged from 1 month to 4 years. Surgery was the treatment proposed to all patients, with a variable extension of resection. LDSM is a rare disease that is burdened by poor prognosis. Early diagnosis is crucial, even if difficult to achieve. Surgery and radiotherapy are standardized treatments, while targeted therapy and immunotherapy are attractive prospects.
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Affiliation(s)
- Alessandro Vinciguerra
- Otorhinolaryngology Unit, Department of Head and Neck, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Rampi
- Otorhinolaryngology Unit, Department of Head and Neck, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Giordano Resti
- Ophthalmologic Unit, Department of Head and Neck, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Diego Barbieri
- Otorhinolaryngology Unit, Department of Head and Neck, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mario Bussi
- Otorhinolaryngology Unit, Department of Head and Neck, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Trimarchi
- Otorhinolaryngology Unit, Department of Head and Neck, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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9
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Diez-Montero C, Marqués-Fernandez V, De Las Heras Florez P, Galindo-Ferreiro A. Abordaje del paciente con patología de la vía lagrimal: Indicaciones quirúrgicas. REVISTA ORL 2020. [DOI: 10.14201/orl.24145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción y objetivo: Realizar una revisión y actualización del diagnóstico e indicaciones terapéuticas de la obstrucción de la vía nasolagrimal (ONL), así como un abordaje clínico sencillo, precoz y práctico. Método: revisión de la literatura publicada referente a la ONL y sobre la manera actual de enfocar esta patología. Resultados: El lagrimeo excesivo (epífora) puede tener un origen funcional o anatómico. Las obstrucciones funcionales son secundarias al fracaso de la bomba lagrimal, mientras que la obstrucción anatómica es causada por un obstáculo físico a lo largo de la vía lagrimal que impide el drenaje de la misma en la cavidad nasal. La pseudoepífora (lagrimeo reflejo), por el contrario, es secundaria a la presencia de patología de la superficie ocular (ojo seco) o a estímulos mecánicos, químicos, infecciosos o psíquicos. Hasta un 40% de los pacientes referidos a consultas de oftalmología por lagrimeo/epífora, presentan un ojo seco con lagrimeo reflejo, sin obstrucción anatómica de la vía lagrimal. Conclusiones: El lagrimeo es uno de los síntomas más frecuentes en las consultas de oftalmología. Sin embargo, son muy numerosos los factores etiológicos que pueden conducir a esta queja. Es fundamental un estudio multidisciplinar (oftalmología y otorrinolaringología) para realizar un correcto diagnóstico. El éxito de la cirugía lagrimal reside en una correcta indicación quirúrgica.
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10
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Cikrikci S, Erkan E, Agdas F. Association between septoplasty, Lund-Mackay score and Lund-Kennedy score with endoscopic dacryocystorhinostomy results. Orbit 2020; 40:274-280. [PMID: 32594817 DOI: 10.1080/01676830.2020.1782441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To compare endoscopic dacryocystorhinostomy (endo-DCR) + septoplasty with endo-DCR alone and determine the relationship between sinusitis and endo-DCR surgery results. METHODS Our study included 55 patients with nasolacrimal duct obstruction (NLDO) between June 2017 and June 2019. Patients were divided into two groups as endo-DCR alone and endo-DCR + septoplasty. Patients' symptoms were thoroughly evaluated and scored using the Lund-Mackay (LM) score and the Lund-Kennedy (LK) system. According to LK endoscopy scoring; those with a score of 0 were determined as group 1 (40 (58.8%) cases); and those with a score greater than 0 were determined as group 2 (28(41.2%) cases). According to LM CT scoring system, cases whose score was 0 were determined as group 1 (44(%66.2) cases); those greater than 0 were determined as group 2 (23(33.8%) cases). RESULTS A total of 68 endo-DCR surgeries, 42 unilateral and 13 bilateral, were performed. Forty one cases (60.3%) were managed with endo-DCR alone, and septoplasty surgery was performed in 27 (39.7%) cases in addition to endo-DCR due to septum deviation. There was no statistically significant difference in functional and anatomical success between the two groups in terms of surgery type (anatomical success p = .353, functional success p = .528); LK endoscopy scoring (anatomical success p = .956, functional success p = .925) and LM CT scoring system (anatomical success p = .202, functional success p = .172). CONCLUSION LK endoscopy and LM CT scores did not show any influence on functional and anatomic outcomes in endo-DCR cases.
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Affiliation(s)
- Sercan Cikrikci
- Department of Otolaryngology, Head and Neck Surgery, Yozgat City Hospital, Yozgat, Turkey
| | - Erol Erkan
- Department of Ophthalmology, Yozgat City Hospital, Yozgat, Turkey
| | - Fatih Agdas
- Department of Otolaryngology, Head and Neck Surgery, Yozgat City Hospital, Yozgat, Turkey
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11
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Vinciguerra A, Nonis A, Giordano Resti A, Bussi M, Trimarchi M. Best treatments available for distal acquired lacrimal obstruction: A systematic review and meta‐analysis. Clin Otolaryngol 2020; 45:545-557. [DOI: 10.1111/coa.13551] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/31/2020] [Accepted: 04/13/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Alessandro Vinciguerra
- Division of Head and Neck department Otorhinolaryngology unit IRCCS San Raffaele Scientific Institute Milano Italy
| | - Alessandro Nonis
- CUSSB University Centre for Statistics in the Biomedical Sciences San Raffaele Hospital Vita‐Salute University Milano Italy
| | - Antonio Giordano Resti
- Division of Head and Neck department Ophthalmologic unit IRCCS San Raffaele Scientific Institute Milano Italy
| | - Mario Bussi
- Division of Head and Neck department Otorhinolaryngology unit IRCCS San Raffaele Scientific Institute Milano Italy
| | - Matteo Trimarchi
- Division of Head and Neck department Otorhinolaryngology unit IRCCS San Raffaele Scientific Institute Milano Italy
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12
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Trimarchi M, Giordano Resti A, Vinciguerra A, Danè G, Bussi M. Dacryocystorhinostomy: Evolution of endoscopic techniques after 498 cases. Eur J Ophthalmol 2019; 30:998-1003. [DOI: 10.1177/1120672119854582] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Endoscopic dacryocystorhinostomy is a well-known surgical practice used to treat nasolacrimal duct obstruction and widely considered as a valid alternative to external approaches. Purpose: We present a retrospective case series of 498 endoscopic dacryocystorhinostomies on 401 patients, from July 2004 to May 2018, at the Department of Otolaryngology, San Raffaele Hospital, Milan, Italy. Methods: Of the 498 procedures, 426 were unilateral and 72 were bilateral dacryocystorhinostomy. All patients underwent routine preoperative workup including fluorescein test (Jones test 1–2), probing and irrigation of the lacrimal way, nasal endoscopy, and maxilla-facial computed tomography scan. Surgical technique was based on nasal endoscopic dacryocystorhinostomy followed by positioning of a Catalano’s silicone stent, which was left in place for about 3 months. Anatomical success was defined as a patent ostium on irrigation, whereas functional success was defined as free lacrimal flow on functional test and resolution of epiphora. Results: Anatomic success was achieved in 91.54% cases in primary dacryocystorhinostomy and in 89.36% after revision, whereas functional success was obtained in 90.4% in primary and 85.1% in secondary dacryocystorhinostomies. After a second revision of endoscopic dacryocystorhinostomy, anatomical success was achieved in 90.1% and functional success in 88.7% of procedures. Conclusion: Our results confirm that endoscopic dacryocystorhinostomy can be considered as a valid surgical approach to primary nasolacrimal duct obstruction and revision cases. The key aspects in achieving functional and anatomical results are meticulous surgical procedure and precise follow-up.
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Affiliation(s)
- Matteo Trimarchi
- Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Antonio Giordano Resti
- Division of Ophthalmology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Alessandro Vinciguerra
- Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Giulia Danè
- Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Mario Bussi
- Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
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Fujimoto M, Uji A, Ogino K, Akagi T, Yoshimura N. Lacrimal Canaliculus Imaging Using Optical Coherence Tomography Dacryography. Sci Rep 2018; 8:9808. [PMID: 29955074 PMCID: PMC6023928 DOI: 10.1038/s41598-018-27802-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/08/2018] [Indexed: 11/09/2022] Open
Abstract
Lacrimal canaliculus (LC) has a key role in tear drainage, but it is difficult to evaluate the LC in detail, using the existing examinations. In this study, our novel LC imaging technique provided the high-resolution images of LC in a non-invasive manner. Three-dimensional images of LC were acquired via the palpebral conjunctiva from 20 healthy volunteers (20 eyes) and 10 patients with various lacrimal disorders (10 eyes), using optical coherence tomography (OCT) dacryography (OCTD). The LC images showed morphological differences between the vertical and horizontal segments. The function of LC could be evaluated by measuring the intralumen signal intensity over time after instillation of a contrast agent (2% rebamipide ophthalmic suspension). OCTD clearly visualised the blind extremity of the LC in four patients with punctal obstruction, which was useful for deciding the punctal incision location. In one patient with canalicular obstruction, contrast agent successfully highlighted the LC that had become narrow toward the site of obstruction. Significant differences were not found in the function and morphology of LC between the patients with NLDO and the healthy subjects. OCTD may be a useful tool for LC imaging, because it facilitates quantitative and simultaneous evaluation of LC morphology and function.
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Affiliation(s)
- Masahiro Fujimoto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Akihito Uji
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Ken Ogino
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tadamichi Akagi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Nagahisa Yoshimura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Preoperative imaging should be performed prior to surgery in all cases of acquired nasolacrimal obstruction-Yes. Eye (Lond) 2016; 31:351-352. [PMID: 27813518 DOI: 10.1038/eye.2016.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Nasolacrimal System Aeration on Computed Tomographic Imaging: Sex and Age Variation. Ophthalmic Plast Reconstr Surg 2016; 32:11-6. [PMID: 25675167 DOI: 10.1097/iop.0000000000000392] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate variation in aeration of the nasolacrimal drainage system between age groups and genders, and to report the reliability of repeated aeration grading and nasolacrimal canal measurements on CT. METHODS Retrospective review of CT images from 92 individuals, 60 female and 32 male, was conducted by 3 independent reviewers for the presence of air within the nasolacrimal drainage system. Diameter and area measurements were also obtained at the smallest identifiable portion of the nasolacrimal canal by 2 independent reviewers. RESULTS When air is present on CT, it is seen more fully throughout the nasolacrimal system in men as compared to women. Age data demonstrate that patients from the third and fourth decade have significantly more aeration than older patients. Diameter and area of the nasolacrimal duct within the canal at its narrowest point revealed no correlation with sex, age, or nasolacrimal system aeration. Inter-reviewer reliability shows strong repeatability of aeration grading and nasolacrimal duct measurements between multiple reviewers. CONCLUSIONS The results suggest CT is reliable and repeatable modality to assess nasolacrimal system aeration and nasolacrimal duct diameter. Decreased aeration of the nasolacrimal system in females and the elderly mirrors epidemiologic trends for those at risk to develop primary acquired nasolacrimal duct obstruction. Variables in nasolacrimal drainage system anatomy, specifically nasolacrimal duct diameter and area, did not vary between sexes or age groups, suggesting aeration may be an overlooked variable in nasolacrimal system function.
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Czyz CN, Bacon TS, Stacey AW, Cahill EN, Costin BR, Karanfilov BI, Cahill KV. Nasolacrimal system aeration on computed tomographic imaging: effects of patient positioning and scan orientation. Clin Ophthalmol 2015; 9:469-73. [PMID: 25792799 PMCID: PMC4362979 DOI: 10.2147/opth.s80752] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the impact of patient positioning and scan orientation on the appearance of air in the nasolacrimal drainage system on computed tomography (CT) imaging, and the repeatability of the observations. Methods This was a retrospective analysis of CT images for 92 patients. Results Air was found to be present more fully in the upright-position group as compared with the supine-position group. Comparing axial and coronal scan orientation, no difference in aeration was found, except for the nasolacrimal duct in the upright-position group. Conclusion Patient position should be accounted for in diagnostic conclusions and treatment decisions based on CT.
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Affiliation(s)
- Craig N Czyz
- Section Oculofacial Plastic and Reconstructive Surgery, Ohio University/OhioHealth, Columbus, OH, USA
| | - Thomas S Bacon
- Department of Medical Education, Mount Carmel Health Systems, Columbus, OH, USA
| | - Andrew W Stacey
- Department of Ophthalmology, University of Michigan, Ann Arbor, MI, USA
| | - Eva N Cahill
- Department of Biology, Wittenberg University, Springfield, OH, USA
| | - Bryan R Costin
- Department of Ophthalmology, William H Havener Eye Institute, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Kenneth V Cahill
- Department of Ophthalmology, William H Havener Eye Institute, Ohio State University Wexner Medical Center, Columbus, OH, USA
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Zhang J, Chen L, Wang QX, Liu R, Zhu WZ, Luo X, Peng L, Xiong W. Diagnostic performance of the three-dimensional fast spin echo-Cube sequence in comparison with a conventional imaging protocol in evaluation of the lachrymal drainage system. Eur Radiol 2014; 25:635-43. [DOI: 10.1007/s00330-014-3462-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 09/29/2014] [Indexed: 10/24/2022]
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