Gore Sri K, Naveed Hasan, Hamilton Jane, Rene Cornelius, Rose Geoffrey E, Davagnanam Indran
*Adnexal Service, Addenbrookes Hospital, Cambridge; †Adnexal Service, Moorfields Eye Hospital, London; ‡Radiology Department, Moorfields Eye Hospital, London; and §Brain Repair & Rehabilitation Unit, Institute of Neurology, London, United Kingdom.
Ophthalmic Plast Reconstr Surg. 2015 Jul-Aug;31(4):328-31. doi: 10.1097/IOP.0000000000000457.
To compare, in black Africans and Caucasians, the radiological anatomy of the intranasal structures and lacrimal sac fossa as relevant to dacryocystorhinostomy.
0.75 mm section cranio-orbital computed tomography scans from 72 patients (42 black Africans and 30 Caucasian) were included in this retrospective observational case series. Only one orbit from each scan was utilized. The main outcome measures were: the thickness and proportions of the lacrimal bone and frontal process of the maxilla evaluated at 3 axial planes (upper, middle, lower) in the lacrimal sac fossa; 2 measurements of maxillary thickness were obtained at each plane-namely, the "midpoint thickness" and the "maximum thickness." The anterior extent of the nasal mucosa was also evaluated.
The frontal process of the maxilla was thickest inferiorly (p < 0.001) and the maximum maxillary thickness was significantly thicker in black Africans as compared with Caucasians (p < 0.001) at all planes. At midfossa level, the proportion of maxillary bone forming the lacrimal fossa wall was significantly greater in black Africans (p < 0.01). In contrast, the length of nasal mucosa available for creation of an anastomosis, as estimated from the greatest mucosal height, was significantly greater in Caucasians (p < 0.01).
Black Africans have a lacrimal sac fossa bounded by thicker maxillary bone, this bone constituting a higher proportion of the fossa wall at its midpoint, and also have significantly less nasal mucosa available for soft-tissue anastomosis during lacrimal drainage surgery. The anterior lacrimal crest, comprising the frontal process of the maxilla, was thickest at the lowest plane in both black Africans and Caucasians.
比较黑非洲人和高加索人鼻内结构及泪囊窝的放射解剖学，这些结构与泪囊鼻腔吻合术相关。
本回顾性观察病例系列纳入了72例患者（42名黑非洲人和30名高加索人）的0.75毫米层厚颅眶计算机断层扫描。每次扫描仅使用一侧眼眶。主要观察指标包括：在泪囊窝的3个轴向平面（上、中、下）评估泪骨和上颌骨额突的厚度及比例；在每个平面获取2个上颌骨厚度测量值，即“中点厚度”和“最大厚度”。还评估了鼻黏膜的前部范围。
上颌骨额突在下方最厚（p < 0.001），在所有平面上，黑非洲人的上颌骨最大厚度均显著厚于高加索人（p < 0.001）。在中窝水平，构成泪囊窝壁的上颌骨比例在黑非洲人中显著更大（p < 0.01）。相比之下，根据最大黏膜高度估计，可用于建立吻合的鼻黏膜长度在高加索人中显著更长（p < 0.01）。
黑非洲人的泪囊窝由较厚的上颌骨界定，该骨在泪囊窝中点构成更高比例的窝壁，并且在泪道引流手术期间可用于软组织吻合的鼻黏膜也显著更少。在黑非洲人和高加索人中，由上颌骨额突构成的泪前嵴在最低平面最厚。
