Lee Joon Sik, Lee Hwa, Kim Jung Wan, Chang Minwook, Park Minsoo, Baek Sehyun
From the *Department of Ophthalmology, Korea University College of Medicine; and †Department of Ophthalmology, KEPCO Medical Center, Seoul, Korea.
J Craniofac Surg. 2013 Sep;24(5):1544-8. doi: 10.1097/SCS.0b013e318290260d.
The objective of this study was to evaluate the association of facial asymmetry and nasal septal deviation in acquired unilateral nasolacrimal duct (NLD) obstruction.
A retrospective survey was conducted of 39 patients (6 male and 33 female) who had undergone endoscopic dacryocystorhinostomy at the Korea University Ansan Hospital. Patients with trauma to the orbit or any known lacrimal duct disease were excluded. The primary goal was to obtain a descriptive analysis of facial asymmetry and nasal septal deviation. We analyzed the results and identified associations with facial asymmetry and nasal septal deviation in NLD obstruction and determined the influence of the degree of asymmetry and deviation on the results.
The mean length of the straight line drawn from the lateral canthus to the corner of the mouth was 10.2 cm in the right eye and 9.9 cm in the left eye, and the difference was statistically significant by the Wilcoxon signed rank test (P = 0.043). The laterality of NLD obstruction corresponded to the smaller side of the face in 27 of 39 patients (P = 0.038, κ = 0.753 by cross-table McNemar test). Also, a significant positive linear relation of correspondence of NLD obstruction to the smaller side of the face was observed according to the degree of facial asymmetry (P = 0.043 by linear-by-linear association). Nasolacrimal duct obstruction appeared to occur on the side in which the nasal septum was deviated in 25 of 39 patients (P = 0.043, κ = 0.652 by cross-table McNemar test). Significant positive linear relation of correspondence of NLD obstruction to the side in which the nasal septum was deviated was also observed according to the degree of nasal septal deviation (P = 0.045 by linear-by-linear association). There is also a trend of nasal septal deviation toward the smaller side of the face (total 25 of 39 patients, P = 0.043 by cross-table McNemar test).
Unilateral NLD obstruction appears to occur on the side in which the nasal septum is deviated, and nasal septal deviation tends to be toward the smaller side of the face. Also, the degree of facial asymmetry and nasal septal deviation may affect NLD obstruction. This study showed that facial asymmetry and nasal septal deviation could be a cause of unilateral NLD obstruction. This finding can aid in differentiating lacrimal duct obstruction, especially when combined with physical examination.
本研究的目的是评估获得性单侧鼻泪管（NLD）阻塞中面部不对称与鼻中隔偏曲之间的关联。
对韩国大学安山医院39例接受鼻内镜下泪囊鼻腔造口术的患者（6例男性和33例女性）进行回顾性调查。排除眼眶外伤或任何已知泪道疾病的患者。主要目标是对面部不对称和鼻中隔偏曲进行描述性分析。我们分析结果，确定NLD阻塞与面部不对称和鼻中隔偏曲之间的关联，并确定不对称和偏曲程度对结果的影响。
从外眦至口角所画直线的平均长度，右眼为10.2cm，左眼为9.9cm，经Wilcoxon符号秩检验，差异具有统计学意义（P = 0.043）。39例患者中，27例NLD阻塞的侧别与面部较小侧相对应（交叉表McNemar检验，P = 0.038，κ = 0.753）。此外，根据面部不对称程度，观察到NLD阻塞与面部较小侧之间存在显著的正线性对应关系（线性-线性关联检验，P = 0.043）。39例患者中，25例鼻泪管阻塞似乎发生在鼻中隔偏曲的一侧（交叉表McNemar检验，P = 0.043，κ = 0.652）。根据鼻中隔偏曲程度，也观察到NLD阻塞与鼻中隔偏曲侧之间存在显著的正线性对应关系（线性-线性关联检验，P = 0.045）。鼻中隔也有向面部较小侧偏曲的趋势（39例患者中共有25例如此，交叉表McNemar检验，P = 0.043）。
单侧NLD阻塞似乎发生在鼻中隔偏曲的一侧，且鼻中隔偏曲倾向于朝向面部较小侧。此外，面部不对称程度和鼻中隔偏曲可能影响NLD阻塞。本研究表明，面部不对称和鼻中隔偏曲可能是单侧NLD阻塞的原因。这一发现有助于鉴别泪道阻塞，尤其是在结合体格检查时。
