Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Otolaryngol Head Neck Surg. 2014 May;150(5):901-5. doi: 10.1177/0194599814524700. Epub 2014 Mar 4.
To identify key anatomic considerations in endoscopic revision dacryocystorhinostomy (r-EnDCR) following failed external dacryocystorhinostomy (ExDCR).
Case series with chart review.
Tertiary care academic medical center.
A retrospective review of patients undergoing r-EnDCR after failed ExDCR over the past 6 years was performed. Those with primary or previous EnDCR, proximal nasolacrimal procedures, and nasolacrimal lesions were excluded. All patients had a preoperative maxillofacial computed tomography (CT) scan. Data were collected on patient demographics, clinical characteristics, and radiographic findings. A classification system for the anterior ethmoid-lacrimal fossa complex anatomy was developed.
Twenty-five r-EnDCRs were performed on 22 patients after failed ExDCR. Concurrent sinusitis and previous maxillofacial trauma were seen in 9% (2/22) of patients. CT scan demonstrated anterior ethmoid pneumatization with agger nasi cells in 88% (22/25) of patients, and 95% (21/22) of these partially overlapped the medial aspect of the lacrimal fossa, resulting in a DCR ostium located within the middle meatus. The presence of ipsilateral septal deviation, concha bullosa, and middle turbinate lateralization or scarring to the lateral nasal wall was seen in 24% (6/25).
In this case series, a large proportion of patients who had failed an ExDCR had an agger nasi cell, suggesting that variability of the anterior ethmoid anatomy may contribute to surgical failure following ExDCR. CT imaging and endoscopy, which are not always performed prior to ExDCR, can help to elucidate the pattern of agger nasi pneumatization as it relates to the lacrimal fossa and to optimize placement of the DCR ostium.
确定内镜下鼻内泪囊吻合术（r-EnDCR）修复失败的外鼻内泪囊吻合术（ExDCR）的关键解剖学考虑因素。
病例系列和图表回顾。
三级保健学术医疗中心。
对过去 6 年中因 ExDCR 失败而行 r-EnDCR 的患者进行回顾性研究。排除了原发性或先前的 EnDCR、鼻内泪囊程序和鼻泪管病变的患者。所有患者均进行了术前颌面计算机断层扫描（CT）扫描。收集患者的人口统计学、临床特征和影像学发现的数据。开发了一种用于前筛窦-泪囊窝复合体解剖的分类系统。
22 例患者中有 25 例因 ExDCR 失败而行 r-EnDCR。9%（2/22）的患者并发鼻窦炎和先前的颌面外伤。CT 扫描显示 88%（22/25）的患者有前筛窦气腔，其中 95%（21/22）的患者部分重叠于泪囊窝的内侧，导致 DCR 口位于中鼻道内。同侧鼻中隔偏曲、鼻甲卷曲、中鼻甲外侧化或外侧鼻甲骨向外侧移位或瘢痕形成的发生率为 24%（6/25）。
在本病例系列中，很大一部分 ExDCR 失败的患者有鼻丘气房，这表明前筛窦解剖的变异性可能导致 ExDCR 后手术失败。并非总是在 ExDCR 之前进行的 CT 成像和内镜检查可以帮助阐明鼻丘气腔与泪囊窝的关系，并优化 DCR 口的位置。
