Nagieb N, Hamed A, Abdel- bary M, Mosalmy S


Obstructive epiphora is a common problem especially among adult and elderly.
Dacryocystorhinostomy (DCR) is the treatment of choice for the obstruction. Anatomical variations of
the lacrimal sac make DCR localization,difficult to have reproducibility endonasaly. Objective: To
establish the accurate intranasal anatomical landmarks for easier localization of the lacrimal sac
through the lateral nasal wall during endoscopic DCR (EDCR). Setting:Anatomy and
Otorhinolaryngolog departments,Zagazig University. Patients and methods: Ten adult cadaver sagittal
head sections were evaluated. During dissections, the maxillary line, , axilla of middle turbinate, and
lacrimal sac(LS) were exposed.The relations between the sac especially its inferior border and axilla
of middle turbinate, maxillary line and its (M) point were studied.Results:The mean height of LS was
11.2mm, whereas the mean width was 4.5mm.The right and left sides did not show any significant
statistical difference.The upper border of the LS was situated above the axilla in all cases. The anterior
border of LS was anterior to the axilla in 70% ,while the posterior border of the sac was posterior to
the axilla in 80% of cases.The study evaluated the localization of LS to the maxillary line, which is of
clinical importance in intranasal osteotomy during DCR.The lower border of LS was at same level of
(M) point in 60%,while it was higher than this level in 30%, and below it in 10%. Conclusion:
Localization of the inferior part of LS is valid in 60% of cases and very difficult and hazardous in
40%.. The accuracy of localization of the LS can be increased by using intrasac fiberoptic
transillumination using halogen light or laser beam

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