Day Shelley, Hwang Thomas N, Pletcher Steven D, Bhatki Amol, McCulley Timothy J
Department of Ophthalmology, University of California San Francisco, San Francisco, California 94143, USA.
Ophthalmic Plast Reconstr Surg. 2008 Jul-Aug;24(4):338-40. doi: 10.1097/IOP.0b013e31817e6133.
The authors describe dacryocystorhinostomy performed with CT guidance. A 53-year-old man with a history of cocaine abuse was referred for bilateral nasolacrimal duct obstruction. Nasal speculum examination revealed an oronasal fistula and obliteration of the inferior nasal septum. Bilaterally, the inferior and middle turbinates were contracted, forming thick scar tissue conglomerates. The loss of normal anatomic landmarks and extensive contracted scar tissue precluded standard dacryocystorhinostomy approaches. Endoscopic dacryocystorhinostomy was therefore undertaken using CT-guided navigation. The location of the superior nasolacrimal duct was identified and subsequently exposed. Dissection was continued superiorly, marsupializing the lacrimal sac. Silicon stents were placed and tied intranasally. Right and left sides were managed similarly. Several months later, following stent removal, the patient was without epiphora. This case demonstrates that CT guidance can be a useful adjunct to standard dacryocystorhinostomy techniques, allowing otherwise challenging surgical cases to be managed effectively and safely.
作者描述了在CT引导下进行的泪囊鼻腔吻合术。一名有可卡因滥用史的53岁男性因双侧鼻泪管阻塞前来就诊。鼻镜检查发现口鼻瘘和鼻中隔下部闭塞。双侧下鼻甲和中鼻甲收缩，形成厚厚的瘢痕组织团块。正常解剖标志的缺失和广泛的瘢痕组织收缩使得标准的泪囊鼻腔吻合术无法实施。因此，采用CT引导导航进行了内镜下泪囊鼻腔吻合术。确定并随后暴露了鼻泪管上段的位置。向上继续进行解剖，使泪囊造袋。在鼻腔内放置并系上硅胶支架。左右两侧的处理方式相同。几个月后，取出支架后，患者不再溢泪。该病例表明，CT引导可以作为标准泪囊鼻腔吻合术技术的有用辅助手段，使原本具有挑战性的手术病例能够得到有效且安全的处理。
