A retrospective anatomical analysis of computed tomographic dacrocystographs (CTDCGS) performed prior to endonasal dacrocystorhinostomy for nasolacrimal obstruction

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Abstract

Purpose: Successful endonasal DCR relies on the identification and modification of local anatomical variations. Preoperative imaging allows for thorough evaluation of nasal and paranasal sinus anatomy.

Methods: A retrospective review of 66 consecutive CTDCG examinations were reviewed in preoperative patients undergoing endonasal DCR. Anatomical details pertaining to the nasal septum, middle turbinate, ethmoid complexes, presence of mucosal disease and site of nasolacrimal obstruction were documented. A review of each operative note was conducted to compare the preoperative surgical plan with the subsequent intervention.

Results: 33 percent of patients undergoing endonasal DCR are likely to require or benefit from adjuvant septal corrective surgery for surgical access. 74 percent of patients had middle turbinates anterior or parallel to the nasolacrimal duct and a further 37 percent had anatomical variations of the middle turbinate that narrowed the middle meatus. A discrete area of nasolacrimal obstruction was not identified in 36 percent of cases suggesting high rates of functional obstruction.

Conclusions: Preoperative imaging facilitates accurate surgical planning, precludes intraoperative surprises and enables effective communication with patients relating to adjuvant surgical procedures.

Additional Info

  • Authors: BT Stew, SJC Fishpool, ST Browning & HB Whittet
  • Keywords: Dacrocystorhinostomy, Dacrocystograph, Endonasal, Anatomy, Surgery
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