Distal lakrimal kanal tıkanıklığına eşlik eden lateral nazal duvar patolojilerinin incelenmesi

Year 2015, Volume: 5 Issue: 2, 68 - 71, 14.01.2016

Murat Kaplan Ethem Şahin Ali Okan Gürsel

Abstract

Amaç: Bu çal›flmada lateral nazal duvar ve sinüs patolojilerinin distal
lakrimal kanal t›kan›kl›¤› etiyolojisindeki rolü araflt›r›lm›flt›r.
Yöntem: Nisan 1999 ile Eylül 2003 tarihleri aras›nda endoskopik
endonazal dakriosistorinostomi ve silikon entübasyonu planlanan 17
kad›n ve 11 erkek hasta çal›flmaya dahil edildi. Hastalar›n lakrimal kanal t›kan›kl›¤› tan›s› için göz kliniklerinde Schirmer testi, flöresein
boya kaybolma testi, Jones I-II testleri, kanaliküler irrigasyon, kanaliküler problama, dakriosistografi, dakriosintigrafi gibi genel oftalmolojik muayeneleri yap›ld›. KBB kliniklerinde nazal kavite patolojileri için anterior rinoskopi ve diagnostik nazal endoskopik muayeneleri yap›ld›. Tüm hastalarda paranazal bilgisayarl› tomografi ile ostiomeatal kompleks hastal›¤›, etmoid hücre opasifikasyonu, konka bülloza, agger nazi hücresi varl›¤› de¤erlendirilerek 50 kontrol olgusundaki bulgular ile Fisher’in ki-kare testiyle karfl›laflt›r›ld›.
Bulgular: Lakrimal kanal t›kan›kl›¤›n oldu¤u tarafta agger nazi hücresi 17 (%60.7), konka bülloza 10 (%35.7), etmoid hücre opasifikasyonu 6 (%21.4), osteomeatal kompleks hastal›¤› 4 (%14.2), bir veya
daha fazla bulgu 21 (%75) hastada saptand›. Bu lateral nazal duvar ve
sinüs patolojileri çal›flma grubunda kontrol grubuna oranla yüksek
bulunmas›na karfl›l›k istatistiksel olarak anlaml› bulunmad›
(p>0.05).
Sonuç: Lateral nazal duvar ve sinüs patolojilerini distal nazolakrimal
sistem t›kan›kl›¤› olan hastalarda yüksek oranda bulmam›za ra¤men
etiyolojisini aç›klamakta yetersiz oldu¤u ve paranazal bilgisayarl› tomografinin bu hastalar›n de¤erlendirilmesinde artan öneme sahip
olaca¤› kan›s›na vard›k. 

Keywords

Lateral nazal duvar patolojileri, distal lakrimalkanal, tıkanıklık

Examination of lateral nasal wall pathologies associated with distal lacrimal duct obstruction

Abstract

Objective: In this study, the role of lateral nasal wall and sinus pathologies in the etiology of distal lacrimal duct disease has been investigated.
Methods: Seventeen female and 11 male patients who were scheduled
for endoscopic endonasal dacryocystorhinostomy and silicon tube intubation between April 1999 and September 2003 were included in the study.
The patients underwent general ophthalmologic examinations such as
Schirmer test, fluorescein dye disappearance test, Jones I-II tests, canalicular irrigation, canalicular probing, dacryocystography, dacryoscintigraphy for the diagnosis of lacrimal duct obstruction. In the clinics of ENT,
for the detection of nasal cavity pathologies, anterior rhinoscopy and
diagnostic nasal endoscopic examinations were performed. All patients
were evaluated during paranasal computed tomographic examinations
regarding osteomeatal complex disease, ethmoid cell opacification, concha bullosa and presence of agger nasi cells and data obtained were compared with findings of 50 control subjects using Fisher’s chi-square tests.
Results: On the side where lacrimal duct obstruction exists, agger nasi
cells were detected in 17 (60.7%) patients, concha bullosa in 10 (35.7%)
patients, ethmoid cell opacification in 6 (21.4%) patients, osteomeatal
complex disease in 4 (14.2%) patients, and one or more than one symptom were detected in 21 (75%) patients. Despite higher number of lateral nasal wall and sinus pathologies in the study group when compared
with the control group, intergroup difference was not statistically significant (p>0.05).
Conclusion: We have concluded that despite the higher rates of lateral nasal wall and sinus pathologies in patients with distal nasolacrimal
system obstruction, its etiology has not been adequately expounded and
paranasal computed tomographies will have increasing importance in
the evaluation of these patients. 

Keywords

Lateral nasal wall pathologies, distal lacrimal duct, obstruction

References

• Hurwitz JJ, Rutherford S. Computerized survey of lacrimal sur- gery patients. Ophthalmology 1986;93:14–9.
• Baratz K, Bartley J, Campbell R, Garrity J. An eyelash nidus for dacryoliths of the lacrimal excretory and secretory systems. Am J Ophthalmol 1991;111:624–7.
• Mc Cormick SA, Linberg JV. Pathology of nasolacrimal duct obstruction. In: Linberg JV, editor. Lacrimal surgery. New York, NY: Churchill Livingstone; 1998. p. 169–202.
• Mc Lean CJ, Rose GE. Postherpetic lacrimal obstruction. Ophthalmology 200;107:496–9.
• Prasad S, Kamath GG, Phillips RP. Lacrimal canalicular stenosis associated with systemic 5-fluorouracil therapy. Acta Ophthalmol Scand 2000;78:110–3.
• Önerci M. Dacryocystorhinostomy. Diagnosis and treatment of nasolacrimal canal obstruction. Rhinology 2002;40:49–65.
• Garfin SW. Etiology of dacryocystitis and epiphora. Arch Ophthalmol 1942;27:167–88.
• Bale RN. Dacryosystitis: bacteriological study and its relation with nasal pathology. Indian J Ophthalmol 1987;35:178–82.
• Gray LP. Relationship of septal deformity to snuffly noses, poor feeding, sticky eyes and blocked nasolacrimal ducts. Int J Pediatr Otorhinolaryngol 1980;2:201–15.
• Bernstein L. Pediatric sinus problems. Otolaryngol Clin North Am 1971;4:127–42.
• Lingberg JV, Mc Cormick SA. Primary acquired nasolacrimal duct obstruction. A clinicopathologic report and biopsy technique. Ophthalmology 1986;93:1055–63.
• Kallman JE, Foster JA, Wulc AE, Yousem MD, Kennedy DW. Computed tomography in lacrimal outflow obstructions. Ophthalmology 1997;104:676–82.
• Stammberger H. Endoscopic endonasal surgery – concepts in treatment of recurring rhinosinusitis. Part I. Anatomic and patho- physiologic considerations. Otolaryngol Head Neck Surg 1986;94:143–7..
• Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope 1991;101:56–64.
• Zinreich SJ. Abidin M, Kennedy DW. Cross-sectional imaging of the nasal cavity and paranasal sinuses. Op Tech Otolaryngol Head Neck Surg 1990;1:94–8.
• Lloyd GA. CT of the paranasal sinuses: study of a control series in the relation to endoscopic sinus surgery. J Laryngol Otol 1990;104:477–81.
• Stammberger HR, Kennedy DW; Anatomic Terminology Group. Paranasal sinuses: anatomic terminology and nomenclature. Ann Otol Rhinol Laryngol Suppl 1995;167:7–16..
• Zinreich SJ, Mattox DE, Kennedy DW, Chisholm HL, Diffley DM, Rosenbaum AE. Concha bullosa: CT evaluation. J Comput Assist Tomogr 1988;12:778–84.
• Calhoun KH, Waggenspack GA, Simpson CB, Hokanson JA, Bailey BJ. CT evaluation of paranasal sinuses in symptomatic and asymptomatic populations. Otolaryngol Head Neck Surg 1991; 104:480–3.
• Clarck ST, Babin RW, Salazar J. The incidence of concha bullosa and its relationship to chronic sinonasal disease. Am J Rhinol 1989;3:11–22.
• Knijnik D. Analyzing endoscopic dacryocystorhinostomy: difficul- ties and solutions. [Article in Portuguese] Arq Bras Oftalmol 2007;70:391–4.
• Habesoglu M, Eriman M, Habesoglu TE, et al. Co-occurrence and possible role of sinonasal anomalies in primary acquired naso- lacrimal duct obstruction. J Craniofac Surg 2013;24:497–500.
• This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported (CC BY
• NC-ND3.0) Licence (http://creativecommons.org/licenses/by-nc-nd/3.0/) which permits unrestricted noncommercial use, distribution, and reproduc
• tion in any medium, provided the original work is properly cited.
• Please cite this article as: Kaplan M, Şahin E, Gürsel AO. Examination of lateral nasal wall pathologies associated with distal lacrimal duct obstruction.
• ENT Updates 2015;5(2):68–71.