RESUMEN
Background: Simultaneous endoscopic septoplasty is often required during endonasal endoscopic dacryocystorhinostomy (En-DCR) to improve access to the lacrimal sac and potentially optimize surgical success rates. In current practice, the decision to proceed to concomitant endoscopic septoplasty during En-DCR in patients with primary acquired nasolacrimal duct obstruction (PANDO) is determined by anterior rhinoscopy and nasal endoscopic examination. However, none of these methods can be used to quantitatively assess the severity of septal deviation to determine the need for concomitant endoscopic septoplasty during En-DCR. This study was thus conducted to develop and validate a radiological prediction model based on computed tomography (CT) to predict the necessity of concomitant endoscopic septoplasty during En-DCR. Methods: Data from 225 patients with PANDO and nasal septal deviation (NSD) who had undergone unilateral En-DCR in a single center from January 2022 to June 2023 were retrospectively analyzed. Least absolute shrinkage and selection operator (LASSO) was used to select predictors for concomitant endoscopic septoplasty during En-DCR. The ultimate model was developed through the application of multivariable logistic regression and subsequently confirmed through assessment with an internal validation cohort. The final model was then visually represented using a nomogram and an online calculator. Results: In this retrospective study of 225 eyes from 225 patients with PANDO and NSD, the training cohort included 157 eyes, and the validation cohort included 68 eyes. CT imaging characteristics including NSD angle [odds ratio (OR) 1.54; 95% confidence interval (CI): 1.32-1.87], NSD location (OR 4.49; 95% CI: 1.25-18.77), NSD direction (OR 5.38; 95% CI: 1.48-24.52), and middle nasal passage width (MNPW) at the surgical side (OR 0.61; 95% CI: 0.43-0.82) were identified as independent predictors for concomitant endoscopic septoplasty during En-DCR. A novel nomogram constructed from these CT signs showed high predictive performance. The area under the curves (AUCs) of the training set and internal validation set were 0.913 and 0.909, respectively. Conclusions: A CT-based radiological prediction model was created to help surgeons determine if concomitant endoscopic septoplasty is needed during En-DCR in patients with PANDO and NSD.
RESUMEN
Purpose: To evaluate the clinical usefulness of digital radiography dacryocystography in patients with primary acquired nasolacrimal duct obstruction prior to endoscopic dacryocystorhinostomy. Methods: All dacryocystography images from 129 patients with primary acquired nasolacrimal duct obstruction were analyzed. Each group was assessed for postoperative epiphora severity using Munk's score via telephone follow-up three years post-surgery. Receiver operating characteristic (ROC) curve was plotted to obtain a suitable cutoff value of the transverse diameter of the lacrimal sac (LS), used to categorize LS size into small (≤4.350 mm) and large (>4.350 mm). Results: Analysis of the transverse diameter of the LS among 129 patients showed a negative correlation between it and Munk's score (r = -0.282, p = 0.001). There was a statistical difference between the surgical outcomes and the sizes of the LS (p = 0.041). The ROC curve analysis showed that the transverse diameter of the LS at 4.350 mm was the ideal cutoff value for the outcome of endoscopic dacryocystorhinostomy, with a sensitivity of 42.2 %, and specificity of 92.3 %. After adjusting for the age and sex, the small LS was associated with an increased risk of postoperative failed outcome (adjusted odds ratio [95 % CI]: 8.628 [1.074, 69.335]). Conclusion: The small LS was independently associated with the failed surgical outcome. Furthermore, the preoperative measurement of the LS transverse diameter serves as one of the reliable predictors for postoperative epiphora severity.