Ai Hui-Yang, Chen Xu-Hui, Hu Qi-Lan, Ai Tao, Ma Shun-Guo, Guo Jing-Min, Xiang Nan, Liu Rong
Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Hubei Key Laboratory of Otolaryngologic and Ophthalmic Diseases, Wuhan, 430030, China.
Curr Med Sci. 2025 Aug;45(4):966-976. doi: 10.1007/s11596-025-00090-8. Epub 2025 Jul 28.
The middle turbinate axilla (MTA) is a crucial anatomical landmark for localizing the lacrimal sac (LS) during endonasal dacryocystorhinostomy (En-DCR). Despite being a standard surgical procedure, En-DCR may lead to severe complications, such as cerebrospinal fluid (CSF) leakage, which is closely associated with anatomical variations between the LS and the anterior skull base (ASB). This study aimed to investigate the anatomical location of the LS relative to the MTA and ASB in Chinese patients with nasolacrimal duct obstruction (NLDO) and analyze the influencing factors.
This cross-sectional study enrolled 227 Chinese patients who were diagnosed with NLDO and underwent computed tomographic dacryocystography (CT-DCG). Anatomical distances between LS and MTA, as well as LS and ASB, were measured using CT-DCG images.
The mean distances from the superior and inferior edges of the LS to the MTA were 9.94 ± 4.70 mm and - 0.23 ± 4.15 mm, respectively. Male patients showed significantly more superior-anterior displacement of the LS compared to female patients (P < 0.001), while patients with chronic dacryocystitis (CD) had an inferior and posterior LS position relative to those with simple NLDO (P = 0.005, P = 0.001). The mean distance from the intersection (Point P) of the superior and posterior boundaries of the LS to the ASB (MP) was 18.35 ± 4.48 mm, which was shorter in females and those with frontal sinus aplasia (P = 0.001; P < 0.001). A subgroup (28/227, 12.3%) with a critical anatomical feature was identified, where the distance from Point Q (10 mm posterior to P) to the ASB (NQ distance) was ≤ 10 mm. This subgroup had a higher prevalence of complete supra-MTA LS positioning (71.4% vs. 41.2%, P = 0.003).
Preoperative CT-DCG provides essential anatomical insights into the spatial relationship between the LS and MTA in Chinese patients with NLDO. The LS position varies significantly by gender and disease type, with males showing more superior-anterior and CD patients more inferior-posterior positioning relative to the MTA. Special attention should be paid to patients with frontal sinus aplasia or LS entirely above the MTA to minimize the risk of CSF leakage during En-DCR.
鼻泪管中段鼻甲腋（MTA）是鼻内镜下泪囊鼻腔造口术（En-DCR）中定位泪囊（LS）的关键解剖标志。尽管En-DCR是一种标准的外科手术，但仍可能导致严重并发症，如脑脊液（CSF）漏，这与LS和前颅底（ASB）之间的解剖变异密切相关。本研究旨在探讨中国鼻泪管阻塞（NLDO）患者中LS相对于MTA和ASB的解剖位置，并分析影响因素。
本横断面研究纳入了227例诊断为NLDO并接受计算机断层扫描泪囊造影（CT-DCG）的中国患者。使用CT-DCG图像测量LS与MTA以及LS与ASB之间的解剖距离。
LS上缘和下缘至MTA的平均距离分别为9.94±4.70mm和-0.23±4.15mm。男性患者的LS相对于女性患者明显更向上前方移位（P<0.001），而慢性泪囊炎（CD）患者的LS位置相对于单纯NLDO患者更靠下和靠后（P=0.005，P=0.001）。LS上后边界交点（P点）至ASB（MP）的平均距离为18.35±4.48mm，女性和额窦发育不全患者的该距离较短（P=0.001；P<0.001）。确定了一个具有关键解剖特征的亚组（28/227，12.3%），其中从P点后方10mm处的Q点至ASB的距离（NQ距离）≤10mm。该亚组中LS完全位于MTA上方的发生率更高（71.4%对41.2%，P=0.003）。
术前CT-DCG为中国NLDO患者中LS与MTA之间的空间关系提供了重要的解剖学见解。LS的位置因性别和疾病类型而异，男性相对于MTA更向上前方，CD患者更向下后方。对于额窦发育不全或LS完全位于MTA上方的患者应特别关注，以尽量降低En-DCR期间CSF漏的风险。
