Department of Otolaryngology, Henry Ford Hospital, Detroit, MI.
Int Forum Allergy Rhinol. 2018 Jun;8(6):751-755. doi: 10.1002/alr.22090. Epub 2018 Feb 15.
Addressing anterior maxillary sinus pathology endoscopically that is inaccessible with an endoscopic modified medial maxillectomy requires either a prelacrimal approach (PLA) or an endoscopic Denker's approach (EDA). The PLA involves removing the medial wall of the prelacrimal recess (PLR), which is the bone between the pyriform aperture (PA) and nasolacrimal duct (NLD), from nasal floor to orbital floor. The PLA preserves the inferior turbinate and NLD, whereas both are sacrificed during an EDA. The purpose of this computed tomography (CT)-based study was to determine the anteroposterior and superoinferior dimensions of the medial wall of the PLR.
One hundred thirty-one triplanar sinus CT scans of patients with various rhinologic diseases, but with intact bony PLR walls, were reviewed to assess dimensions of the medial wall of the PLR. The anteroposterior distances from the PA to the inferior-most, middle, and superior-most aspects of the NLD were measured. The height from the nasal floor to orbital floor was also measured. Combining left and right sides, there were 262 measurements.
The anteroposterior distances between the PA and the NLD were as follows: inferior: mean, 8.4 mm (standard error [SE], 0.2; range, 1.9-14.2); middle: mean, 7.6 mm (SE, 0.2; range, 0-13.6); and superior: mean, 5.5 mm (SE, 2.5; range, 0-11.9). The mean height of the medial wall of the PLR was 26.5 mm (SE, 0.2; range, 18.5-39.9).
The anteroposterior and superoinferior dimensions of the medial wall of the PLR are variable, with the anteroposterior dimension being widest inferiorly. Its dimensions should be evaluated preoperatively when considering endoscopic approaches to or through the anterior maxillary sinus.
经内镜改良内侧上颌窦切开术（endoscopic modified medial maxillectomy，EMMM）无法触及的前上颌窦病变，需要经泪前隐窝（prelacrimal recess，PLR）前入路（prelacrimal approach，PLA）或经内镜 Denker 入路（endoscopic Denker's approach，EDA）处理。PLA 涉及从前鼻底到眶底切除泪前隐窝（PLR）的内侧壁，该部位为梨状孔（pyriform aperture，PA）和鼻泪管（nasolacrimal duct，NLD）之间的骨。PLA 保留了下鼻甲和 NLD，而这两者在 EDA 中均被牺牲。本基于计算机断层扫描（computed tomography，CT）的研究旨在确定 PLR 内侧壁的前后和上下维度。
回顾了 131 例患有各种鼻科疾病但 PLR 壁完整的患者的三平面鼻窦 CT 扫描，以评估 PLR 内侧壁的尺寸。测量了从 PA 到 NLD 最下、中间和最上部分的前后距离。还测量了从鼻底到眶底的高度。左右两侧合并，共有 262 个测量值。
PA 与 NLD 之间的前后距离如下：下：平均值 8.4 毫米（标准误差 [standard error，SE]，0.2；范围，1.9-14.2）；中：平均值 7.6 毫米（SE，0.2；范围，0-13.6）；上：平均值 5.5 毫米（SE，2.5；范围，0-11.9）。PLR 内侧壁的平均高度为 26.5 毫米（SE，0.2；范围，18.5-39.9）。
PLR 内侧壁的前后和上下维度是可变的，前后维度在下部最宽。在考虑经内镜从前上颌窦进入或通过前上颌窦的方法时，应在术前评估其维度。
