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Liu Y, Jiang A, Nie S, Cao S, Wumaier A, Ding R, Kuerban M, Zhou R, Lin F, Yang H, Liang X, Huang D, Chen R. CT-Measured Angulation Between the Frontal Bone and Bony Nasolacrimal Duct: Variations in Obstructed and Healthy Lacrimal Ducts. Semin Ophthalmol 2024:1-8. [PMID: 38493299 DOI: 10.1080/08820538.2024.2330501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/09/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE The aim of this study was to analyze the characteristics of CT-measured intersection angle (FB-BNLD) between the frontal bone and bony nasolacrimal duct and to provide suggestions for treating primary acquired nasolacrimal duct obstruction (PANDO) patients in West China. METHODS Three hundred and nine participants' CT were, respectively, evaluated with RadiAnt DICOM Viewer. We defined the FB-BNLD angle >0° as the anterior type and the FB-BNLD angle ≤0° as the posterior type. RESULTS The mean FB-BNLD was -2.52° (95% CI, -3.16° to -1.88°) across all participants, of whom 37.2% were of the anterior type and 62.8% of the posterior type. Approximately 65.0% of the female patients had a posterior FB-BNLD type, and 54.2% of the male patients had an anterior FB-BNLD type (p = .002). Posterior FB-BNLD was the dominant type in the PANDO and control groups (p = .011), and the angle of FB-BNLD was statistically different in both groups (PANDO group, -2.54° to -0.71°; control group, -4.42° to -2.67°; p < .001). Among the male participants, the type of FB-BNLD differed between the two groups (p = .036), with differences in the angle of FB-BNLD (PANDO group, 0.59° to 5.13°; control group, -4.08° to 1.89°; p = .034). There was no difference in the type of FB-BNLD in female participants between the two groups (p = .051). CONCLUSION The present study revealed individual differences in the type of FB-BNLD, with anterior-type majority in males and posterior-type dominance in females. Evaluating the FB-BNLD type on CT can provide a fast method for knowing the nasolacrimal duct condition during planning for lacrimal manipulation.
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Affiliation(s)
- Yong Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Ophthalmologic Center, The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China
| | - Aixin Jiang
- Ophthalmologic Center, The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China
| | - Shihuai Nie
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Shujuan Cao
- Ophthalmologic Center, The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China
| | - Aizezi Wumaier
- Ophthalmologic Center, The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China
| | - Ruxin Ding
- Ophthalmologic Center, The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China
| | - Mayila Kuerban
- Ophthalmologic Center, The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China
| | - Renbing Zhou
- Ophthalmologic Center, The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China
| | - Fangzeng Lin
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Huasheng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xuanwei Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Danping Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Rongxin Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Ophthalmologic Center, The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China
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Lee S, Lee UY, Yang SW, Lee WJ, Kim DH, Youn KH, Kim YS. 3D morphological classification of the nasolacrimal duct: Anatomical study for planning treatment of tear drainage obstruction. Clin Anat 2020; 34:624-633. [PMID: 32889737 DOI: 10.1002/ca.23678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/12/2020] [Accepted: 08/26/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of this study is to analyze and classify morphological features of the nasolacrimal duct (NLD) through 3D reconstruction to help understand the causes and treatment of NLD obstruction. METHODS In this study, we included 63 males and 55 females who underwent autopsy without NLD obstruction with ages ranging from 20 to 78 years. The NLD was defined from the lacrimal fossa to the opening of the BNLD to the inferior meatus, and all continuous CT images showing the NLD were selected. Segmentation was performed semi-automatically, and the reconstruction and measurement of NLD was performed using the Mimics program. RESULTS Overall NLD length, bony nasolacrimal duct (BNLD) length, anteroposterior and transverse diameters at the entrance to the BNLD, anteroposterior and transverse smallest diameters of the BNLD, BNLD volume, and lacrimal sac BNLD angle were significantly higher in males than females (p < .05). BNLD direction in the coronal plane was slightly more likely to be inward. The most common type in both sexes was cylinder type (42.0%), males were more likely to have lower-thicker types (34.1%), and females more likely to have upper-thicker types (22.7%). CONCLUSION There were sex differences in NLD measurements, and females had significantly smaller NLDs. These results may partially explain the increased prevalence of primary acquired NLD obstruction in females. The BNLD tends toward the midline, and inclines posteriorly.
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Affiliation(s)
- Sohyun Lee
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - U-Young Lee
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Suk-Woo Yang
- Department of Ophthalmology, The Catholic University of Korea, Seoul, South Korea
| | - Won-Joon Lee
- Department of Forensic Medicine Investigation, National Forensic Service Seoul Institute, Seoul, South Korea
| | - Dong-Ho Kim
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kwan Hyun Youn
- Division in Biomedical Art, Incheon Catholic University Graduate School, Incheon, South Korea
| | - Yi-Suk Kim
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Sasaki T, Sounou T, Tsuji H, Sugiyama K. Air-insufflated high-definition dacryoendoscopy yields significantly better image quality than conventional dacryoendoscopy. Clin Ophthalmol 2017; 11:1385-1391. [PMID: 28814825 PMCID: PMC5546830 DOI: 10.2147/opth.s135234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose To facilitate the analysis of lacrimal conditions, we utilized high-definition dacryoendoscopy (HDD) and undertook observations with a pressure-controlled air-insufflation system. We report the safety and performance of HDD. Methods In this retrospective, non-randomized clinical trial, 46 patients (14 males and 32 females; age range 39–91 years; mean age ± SD 70.3±12.0 years) who had lacrimal disorders were examined with HDD and conventional dacryoendoscopy (CD). The high-definition dacryoendoscope had 15,000 picture element image fibers and an advanced objective lens. Its outer diameter was 0.9–1.2 mm. Air insufflation was controlled at 0–20 kPa with a digital manometer-based pressure-controlled air-insufflation system to evaluate the quality of the image. The HDD had an air/saline irrigation channel between the outer sheath (outer diameter =1.2 mm) and the metal inner sheath of the endoscope. We used it and the CD in air, saline, and diluted milk saline with and without manual irrigation to quantitatively evaluate the effect of air pressure and saline irrigation on image quality. Results In vivo, the most significant improvement in image quality was demonstrated with air-insufflated (5–15 kPa) HDD, as compared with saline-irrigated HDD and saline-irrigated CD. No emphysema or damage was noted under observation with HDD. In vitro, no significant difference was demonstrated between air-insufflated HDD and saline-irrigated HDD. In vitro, the image quality of air-insufflated HDD was significantly improved as compared with that of saline-irrigated CD. Conclusion Pressure-controlled (5–15 kPa) air-insufflated HDD is safe, and yields significantly better image quality than CD and saline-irrigated HDD.
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Affiliation(s)
| | | | - Hideki Tsuji
- Department of Ophthalmology, Cancer Institute Hospital
| | - Kazuhisa Sugiyama
- Department of Ophthalmology and Visual Science, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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Maliborski A, Różycki R. Diagnostic imaging of the nasolacrimal drainage system. Part I. Radiological anatomy of lacrimal pathways. Physiology of tear secretion and tear outflow. Med Sci Monit 2014; 20:628-38. [PMID: 24743297 PMCID: PMC3999077 DOI: 10.12659/msm.890098] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 01/16/2014] [Indexed: 01/20/2023] Open
Abstract
Excessive watering of the eye is a common condition in ophthalmological practice. It may be the result of excessive production of tear fluid or obstruction and insufficiency of efferent tear pathways. The differentiation between obstruction and insufficiency of the lacrimal pathways is still clinically questionable. In the diagnostic process it is necessary to perform clinical tests and additional diagnostic imaging is often needed. Dacryocystography, with or without the extension of the dynamic phase or subtraction option, still remains the criterion standard for diagnostic imaging of the lacrimal obstruction. It may help to clarify the cause and exact place of the obstruction and provide information for further management, especially surgical treatment. Increasingly, new techniques are used in diagnostic imaging of the lacrimal tract, such as computed tomography, magnetic resonance, and isotopic methods. Adequate knowledge of the anatomy and physiology of the lacrimal system and the secretion and outflow of tears is the basis for proper diagnostic imaging. The purpose of this paper is to present the exact anatomy of the lacrimal system, with particular emphasis on the radiological anatomy and the current state of knowledge about the physiology of tear secretion and drainage.
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Affiliation(s)
- Artur Maliborski
- Department of Medical Radiology, Military Institute of Medicine, Warsaw, Poland
| | - Radosław Różycki
- Department of Ophthalmology, Military Institute of Medicine, Warsaw, Poland
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The orientation of the lacrimal fossa to the bony nasolacrimal canal: an anatomical study. Ophthalmic Plast Reconstr Surg 2013; 28:463-6. [PMID: 23034686 DOI: 10.1097/iop.0b013e31826463d9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine the relative positions of the lacrimal fossa (LF) and the bony nasolacrimal canal (BNLC) in relation to each other and a reference plane. METHODS Forty-two orbits and BNLCs from 21 Asian cadavers (9 men and 12 women; average age at death, 84.4 years; range, 70-99 years) had been fixed in 10% buffered formalin before use. After exposing the LF and the medial half of the BNLC, the authors measured the angles of the longitudinal axis of the LF and the BNLC relative to the aesthetic horizontal plane respectively. Based on these values, the relative orientation of the LF and the BNLC was determined and defined in terms of Δ BNLC-LF. A positive Δ BNLC-LF represents a nasolacrimal canal that descends posteriorly relative to the LF. RESULTS The mean LF, BNLC, and Δ BNLC-LF were 9.5°, 19.8°, and 10.3°, respectively. In 39 passages (92.9%), the Δ BNLC-LF was positive, representing a nasolacrimal canal that is more posteriorly oriented than the LF. In 3 passages (7.1%), the Δ BNLC-LF was equal to or less than 0°; 2 of them (4.8%) had a straight course and 1 passage (2.4%) had a negative value. CONCLUSIONS In most patients, the BNLC is directed more posteriorly than the LF. This finding may help in preventing an inadvertent false passage during probing and intubation in patients with epiphora.
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