ABSTRACT
The objective of the present work was to study syntopy of the distal end of the nasolacrimal duct based on the results of the vector analysis of the CT-identified anatomical features of the nasal cavity and the paranasal sinuses in 102 patients (204 nasolacrimal channels). The main criterion for inclusion in the study was the absence of traumatic injuries and inflammatory changes in the nasal cavity and the paranasal sinuses. X-ray studies of the distal end of the nasolacrimal duct (NLD), turbinate crest (crista conchalis), the edge of the nasal aperture, and the floor of the nasal cavity were carried out. The vector and angle measurements were made with respect to the bottom of the nasal cavity in the perpendicular and parallel planes. The study has demonstrated that the distal end of the nasolacrimal duct was located 3.49 mm above the level of crista conchalis of the maxillary bone 19.77 mm and 22.04 mm apart from the edge of the aperture of the nose in the individuals younger than 20 years and in the older subjects respectively. Syntopy of the distal end of NLD relative to the bottom of the nasal cavity did not depend on the sex and age of the patients and was localized at a depth of 13.93 mm from the edge of the aperture of the bone and 11.86 mm above the bottom of the nose.
Subject(s)
Lacrimal Apparatus Diseases , Nasal Cavity , Nasolacrimal Duct , Paranasal Sinuses , Tomography, X-Ray Computed/methods , Adult , Female , Humans , Lacrimal Apparatus Diseases/diagnosis , Lacrimal Apparatus Diseases/surgery , Male , Models, Anatomic , Nasal Cavity/anatomy & histology , Nasal Cavity/diagnostic imaging , Nasal Surgical Procedures/methods , Nasolacrimal Duct/anatomy & histology , Nasolacrimal Duct/diagnostic imaging , Paranasal Sinuses/anatomy & histology , Paranasal Sinuses/diagnostic imaging , Patient SelectionABSTRACT
The objective of the present work was to develop a technique for the endonasal surgical access to the maxillary sinus through crista conchalis of the maxillary bone and to evaluate the effectiveness and safety of the surgical treatment by this method. A total of 210 patients underwent the CT-assisted examination of the paranasal sinuses. The data obtained made it possible to characterize the detailed anatomical structure of crista conchalis of a maxillary bone that forms the anterior part of the medial wall of the maxillary sinus. The syntopy in relation to the distal end of the nasolacrimal canal and the cavity of the maxillary sinus was investigated. The results of the study were used to develop the original technique for endonasal antrotomy that included the 0.5-1.0 cm long vertical section of the mucous membrane at the level of the anterior end of the inferior turbinated bone approximately 1 mm from the edge of the bone aperture of the nose which exposed crista conchalis up to the place of fixation of the inferior turbinated bone. Then, the diamond drill burr was use to carry out trepanation of the medial wall of the maxillary sinus in the region of crista conchalis of the maxillary bone; sanitation of the of the sinus was followed by the apposition of the edges of the incision and their fixation with two sutures. The safety of the proposed surgical technique was confirmed by results of the repeated CT examinations of the paranasal sinus and its effectiveness by the clinical follow-up observations.