Lim Blanche Xiao Hong, Gungab Alexander Gerard Nino L, Boniao Emmanuel Lee Ong, Sundar Gangadhara, Ali Mohammad Javed
Orbit, Oculofacial Surgery, Department of Ophthalmology, National University Hospital Singapore, Singapore.
Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India.
Ophthalmic Plast Reconstr Surg. 2023;39(5):498-500. doi: 10.1097/IOP.0000000000002431. Epub 2023 Jun 20.
The purpose is to study the anatomical variations of the characteristic mucosal folds at the canalicular-lacrimal sac junction and their potential clinical implications.
Twelve lacrimal drainage systems of six fresh frozen Caucasian cadavers were studied to assess the openings of the common canaliculus into the lacrimal sac. A standard endoscopic dacryocystorhinostomy was performed until complete lacrimal sac marsupialization and reflection of the flaps. All specimens were subjected to clinical assessment of lacrimal patency via irrigation. A high-definition nasal endoscopy assessed the internal common opening and the mucosal folds in its close vicinity. Probing at the internal common opening was performed to aid in the assessment of the folds. Videography and photo documentation was performed.
All 12 specimens had a single common canalicular opening. Ten of the 12 specimens (83.3%) were noted to have canalicular/lacrimal sac-mucosal folds (CLS-MF). Anatomical variations were noted across these 10 specimens and included inferior 180° (n = 6), anterior 270° (n = 2), posterior 180° (n = 1), and 360° CLS-MF (n = 1). Cases were randomly chosen to demonstrate the clinical implications of misinterpreting them as canalicular obstructions or the potential to cause an inadvertent false passage.
The inferior 180° was the most common CLS-MF noted in the cadaveric study. It is helpful for clinicians to recognize the prominent CLS-MF and their clinical implications intraoperatively. Further fundamental work is needed to characterize the anatomy and the possible physiological role of CLS-MFs.
研究泪小管-泪囊交界处特征性黏膜皱襞的解剖变异及其潜在的临床意义。
对6具新鲜冷冻的高加索人尸体的12个泪道系统进行研究，以评估泪小管进入泪囊的开口情况。进行标准的内镜下泪囊鼻腔造口术，直至泪囊完全袋状化及瓣翻转。所有标本均通过冲洗进行泪道通畅的临床评估。采用高清鼻内镜评估共同开口内部及其附近的黏膜皱襞。在共同开口内部进行探查以辅助评估皱襞。进行摄像和照片记录。
所有12个标本均有单个泪小管共同开口。12个标本中有10个（83.3%）被发现有泪小管/泪囊黏膜皱襞（CLS-MF）。在这10个标本中观察到解剖变异，包括向下180°（n = 6）、向前270°（n = 2）、向后180°（n = 1）和360°的CLS-MF（n = 1）。随机选取病例以展示将其误判为泪小管阻塞的临床后果或导致意外假道的可能性。
在尸体研究中，向下180°是最常见的CLS-MF。临床医生在术中识别明显的CLS-MF及其临床意义是有帮助的。需要进一步开展基础研究以明确CLS-MF的解剖结构及其可能的生理作用。
