Surgical anatomy of the nasolacrimal duct on the lateral nasal wall as revealed by serial dissections

Abstract

The anatomy of the nasolacrimal duct (NLD) in relation with the lateral nasal wall was studied in 15 half-heads of human adult cadavers by serial photographs of the dissection of the lateral nasal wall. The aim of the study was to determine the intranasal anatomical relationships of the NLD with the lateral nasal wall for surgical reference during endoscopic dacryocystorhinostomy. Following removal of the nasal mucosa anterior to the uncinate process, the exposed bone was removed by drilling. The entire NLD was exposed intranasally. The relationships of the NLD with the maxillary sinus ostium and anterior nasal spine were determined, and the length of the NLD was measured. The morphology of the NLD opening was observed, and its distance from several landmarks were measured. There were three types of intranasal orifice: pin-point, triangular and slit-like. The NLD is located, on average, 24.6 ± 3.56 mm posterior to the anterior nasal spine. The nearest distances between the opening of the NLD and the nasal floor and between the opening of the NLD and the most anterior attachment of the inferior nasal concha were 13.7 ± 3.15 and 14.3 ± 2.05 mm, respectively. The length of the NLD was 21.9 ± 2.03 mm on average. The nearest distances between the NLD and the maxillary sinus ostium was 3.9 ± 0.88 mm. Cadaver dissections and the photographs of the fine dissections provide a more accurate description of the lateral nasal wall anatomy. These data provide valuable anatomical information to the surgeon performing endonasal dacryocystorhinostomy.

Morphological and morphometrical study of the nasal opening of nasolacrimal duct in man

“…Regarding the position, a number of landmarks can be utilized to localise the NLD on the lateral nasal wall according to Orhan et al [9] and Tatlisumak et al [13]. The importance of landmarks, such as the anterior nasal spine, attachment of the inferior nasal concha and palate, can be used to estimate the position of the NLD at the beginning of endoscopic surgery.…”

“…The following distances were measured according to Orhan et al [9] and Tatlisumak et al [13] (Fig. 1): -distance (R) -the vertical distance between the attachment line of the inferior nasal concha to the lateral wall of nasal cavity and the superior point of the opening of NLD; -distance (H) -the vertical length of the opening of the NLD.…”

“…If horizontal, the anteroposterior diameter was measured; -distance (F) -the distance between the inferior point of the opening of the NLD and the floor of the nasal cavity; -distance (A) -the distance between the inferior point of the opening of the NLD and the anterior nasal spine. The location of the opening of NLD was investigated according to Orhan et al [9] and Tatlisumak et al [13] (Fig. 2): A.…”

“…The dacryoendoscope and a nasal endoscope are extremely useful in investigating the site of NLD obstruction [10,11]. Narrow opening of NLD may predispose to chronic inflammation of the nasolacrimal drainage system [13]. These data provide valuable anatomical information to the surgeon performing endonasal dacryocystorhinostomy [13].…”

“…Narrow opening of NLD may predispose to chronic inflammation of the nasolacrimal drainage system [13]. These data provide valuable anatomical information to the surgeon performing endonasal dacryocystorhinostomy [13].…”