Konsulov Stefan
Department of Otorhinolaryngology, Medical University of Plovdiv, Plovdiv, BGR.
Cureus. 2024 Dec 9;16(12):e75433. doi: 10.7759/cureus.75433. eCollection 2024 Dec.
Background Dacryocystitis (DC) is a disease most often caused by an obstruction of the nasolacrimal duct, leading to over-accumulation of tears in the lacrimal sac, epiphora, and aseptic inflammation. External and endoscopic dacryocystorhinostomy (DCR) aims to restore the tear pathway by creating a bypass from the lacrimal sac to the nose. The aim of this study is to investigate superior nasal septal deviation as a possible contributing factor in the incidence and treatment of dacryocystitis. Methods This retrospective study included 36 patients surgically treated for chronic dacryocystitis from September 2019 to September 2024. Results Twenty-eight out of the 36 studied patients (77.8%) were females. The average age of all patients was 66.8 years, with 69.4% being in the 50-70 years age group while 30.6% being older than 70 years. Superior nasal septal deviation was present in all patients, with 18 (50%) cases being towards the side of the DC and 11 (30.6%) away from the side of the DC. In seven cases (19.4%), the septum was S-shaped. In none of the cases in which the endoscopic approach was used was a septoplasty necessary. Concha bullosa was observed in five cases (13.9%) and was treated in all. A total of 32 patients were treated endoscopically (88.9%) and four (11.1%) by the Toti external approach method. The intraoperative microbiologic culture was positive in a total of nine cases (25%), five being coagulase-negative Staphylococci (13.9%), two being S. pneumoniae (2.8%), and one each of S. aureus (2.8%) and Pseudomonas maltophilia (5.6%). A re-stenosis was observed in five patients (13.9%). Conclusion Superior nasal septal deviation is an emerging factor both for the incidence of dacryocystitis and the development of re-stenosis after dacryocystorhinostomy. Further studies are needed to find the exact types of nasal septum deviations carrying the greatest risk for disease development, as well as the role of septoplasty in the result of treatment.
泪囊炎（DC）是一种最常由鼻泪管阻塞引起的疾病，导致泪囊内泪水过度积聚、溢泪和无菌性炎症。外路和内镜下泪囊鼻腔造口术（DCR）旨在通过建立一条从泪囊到鼻腔的旁路来恢复泪液引流途径。本研究的目的是调查鼻中隔上偏作为泪囊炎发病率和治疗的一个可能促成因素。
这项回顾性研究纳入了2019年9月至2024年9月期间接受慢性泪囊炎手术治疗的36例患者。
36例研究患者中有28例（77.8%）为女性。所有患者的平均年龄为66.8岁，其中69.4%在50 - 70岁年龄组，30.6%年龄大于70岁。所有患者均存在鼻中隔上偏，其中18例（50%）偏向泪囊炎一侧，11例（30.6%）远离泪囊炎一侧。7例（19.4%）鼻中隔呈S形。在内镜手术的病例中，无一例需要行鼻中隔成形术。观察到5例（13.9%）存在泡状鼻甲，均进行了治疗。共有32例患者接受了内镜治疗（88.9%），4例（11.1%）采用托蒂外路手术方法治疗。术中微生物培养共有9例（25%）呈阳性，5例为凝固酶阴性葡萄球菌（13.9%），2例为肺炎链球菌（2.8%），金黄色葡萄球菌和嗜麦芽窄食单胞菌各1例（均为2.8%）。5例患者（13.9%）观察到再狭窄。
鼻中隔上偏是泪囊炎发病以及泪囊鼻腔造口术后再狭窄发生的一个新出现的因素。需要进一步研究以确定对疾病发展风险最大的鼻中隔偏曲的确切类型，以及鼻中隔成形术在治疗结果中的作用。
