Endoscopic Surgery of the Lacrimal Drainage System

104 Pages·2015·7.626 MB·English

by  Livio Presutti, Francesco Mattioli

Endoscopic Surgery
of the Lacrimal
Drainage System
Livio Presutti
Francesco Mattioli
Editors
123
Endoscopic Surgery of the Lacrimal
Drainage System

Livio Presutti (cid:129) Francesco Mattioli
Editors
Endoscopic Surgery of
the Lacrimal Drainage
System
Editors
Livio Presutti Francesco Mattioli
Modena Head and Neck Department
Italy University Hospital of Modena
Modena
Italy
ISBN 978-3-319-20632-5 ISBN 978-3-319-20633-2 (eBook)
DOI 10.1007/978-3-319-20633-2
Library of Congress Control Number: 2015953445
Springer Cham Heidelberg New York Dordrecht London
© Springer International Publishing Switzerland 2016
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Pref ace
In the last 20 years, the development of new technologies and minimally
invasive surgical techniques has contributed to the success of endoscopic
techniques such as endoscopic sinus surgery.
T his book attempts to describe in a simple and direct manner the treatment
of tear way pathology, which is of increasing interest to ENT specialists.
Dacryocystorhinostomy is a surgical procedure to restore the fl ow of tears
into the nose that has revolutionized the management of tear way pathology.
This technique is a clear example of how a corrected multidisciplinary
approach can improve clinical and therapeutic management.
T he authors describe, step by step, the endoscopic technique, focus on
surgical anatomy and points of risk, and the possible complications associ-
ated with high-complexity anatomical surgical fi elds.
T his book is targeted toward ENT specialists who may benefi t from the
practical and systematic approach taken in this book to this type of surgery.
We hope that this book would serve as a guide and tool for new surgeons and
increase their confi dence with endoscopic sinus anatomy, dacryocistorhinos-
tomy procedures, and correct management of diagnostic-therapeutic
fl owcharts.
Modena, Italy Livio Presutti
Francesco Mattioli
v

Contents
1 Anatomy of the Lacrimal Drainage System . . . . . . . . . . . . . . . . 1
Daniele Marchioni, Margherita Bettini, and Davide Soloperto
2 Physiology of the Lacrimal Drainage System . . . . . . . . . . . . . . . 13
Elio Maria Cunsolo, Elisa Cigarini, and Marcella Menichetti
3 Lacrimal Drainage System Diseases . . . . . . . . . . . . . . . . . . . . . . 23
Francesco Mattioli, Sara Valerini, Marco Bonali,
and Gabriele Molteni
4 Imaging of the Lacrimal Drainage System
and Interventional Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Davide Farina, Francesco Laffranchi, Marco Ravanelli,
Andrea Borghesi, and Roberto Maroldi
5 Epiphora and Indications to Surgery . . . . . . . . . . . . . . . . . . . . . 45
Isida Cena, Matteo Alicandri-Ciufelli,
and Federico Gioacchini
6 Endoscopic Dacryocystorhinostomy . . . . . . . . . . . . . . . . . . . . . . 53
Marco Trebbi, Francesco Mattioli, Davide Soloperto,
Margherita Bettini, and Livio Presutti
7 Pediatric Pathologies and Indication for Surgery . . . . . . . . . . . 63
Angelo Ghidini, Maria Paolo Alberici, and Michael Ghirelli
8 Dacryocystorhinostomy in Revision Surgery . . . . . . . . . . . . . . . 77
Greco Marco Giuseppe, Guarino Pierre,
Tassi Sauro, and Livio Presutti
9 Lacrimal Probe, Stent, and Incannulation . . . . . . . . . . . . . . . . . 85
Domenico Villari, Pierre Guarino, and Marco Ruberto
10 Complications of Endoscopic DCR . . . . . . . . . . . . . . . . . . . . . . . 91
Davide Mattavelli, Davide Lombardi, Marco Ferrari,
and Piero Nicolai
vii
1
Anatomy of the Lacrimal Drainage
System
Daniele Marchioni , Margherita Bettini ,
and Davide Soloperto
1.1 Introduction
Core Messages
This chapter provides a detailed description of
the embryology, anatomy, and histology of the
(cid:129) The knowledge of the anatomy is man-
nasolacrimal structures.
datory for both opthalmologies and oto-
T he nasolacrimal system can be divided into
rhinolaryngologies to understand the
two parts (Fig. 1 .1 ):
physiology, the pathology, and the sur-
gical approaches to the nasolacrimal
(cid:129) Secretory system (main and minor lacrimal
system.
glands, eyelids) that forms the tear fi lm and
(cid:129) The nasolacrimal drainage system can
hand it out on the ocular surface
de divided in two parts: the secretory
(cid:129) E xcretory system (upper and lower puncta,
part which includes main and minor lac-
canaliculi, lacrimal sac, nasolacrimal duct)
rimal glands and eyelids and the excre-
that drains tears from the eye to the nasal cav-
tory part which includes upper and
ity (Fig. 1.2 )
lower puncta, canaliculi, lacrimal sac,
and nasolacrimal duct.
(cid:129) T he lacrimal drainage from the eye to
1.2 Embryology
the nose is due to complex mechanisms
that involve muscular and ligamental
Knowledge of the embryology is necessary to
structures of the medial cantus of the
understand congenital abnormalities of the lacri-
eye.
mal drainage system.
T he lacrimal gland develops at one and a half
month’s gestation as solid epithelial buds arise
from the ectoderm of the superior conjunctiva
fornix; at 13–14 weeks of gestation, arborization
of the glandular parenchyma begins and the gland
organizes itself in glandular lobe [1 , 2 ]. The
D. Marchioni (*) (cid:129) M. Bettini (cid:129) D. Soloperto development continues until 3–4 years after birth.
Department of Head and Neck , University Hospital
At 32 days of embryonic gestation, the max-
of Modena , Modena , Italy
illary and frontonasal prominences appear and a
e-mail: [email protected]; bettini.
[email protected] groove forms between them (Fig. 1.3a ).
© Springer International Publishing Switzerland 2016 1
L. Presutti, F. Mattioli (eds.), Endoscopic Surgery of the Lacrimal Drainage System,
DOI 10.1007/978-3-319-20633-2_1
2 D. Marchioni et al.

Lacrimal gland
Aponevrosis of superior
eyelied lift
Part eyelid
of the lacrimal gland
Lacrimal ducts
Conjunctiva
Lacrimal sac Lacrimal points
Nasal septum
Nasocacrimal duct
Middle
turbinate Maxillary sinus
Inferior
turbinate
Inferior meatus of
nasla cavity
Fig. 1.1 Structure of the nasolacrimal drainage system
to form the lacrimal sac and gives off two col-
umns of cells that grow into the eyelid margins
to become the canaliculi (Fig. 1.3b–c ).
Canalization of the epithelial cords begins at 4
months of gestation proceeding fi rst in the lacri-
mal sac, then in the canaliculi and at last in the
nasolacrimal duct [3 ]. Rapid growth of the max-
illary bone in relation to the frontal bone results
in greater lateral stretching of the inferior cana-
liculus with a subsequent lateral position of the
inferior punctum with respect to the superior
punctum. Remnants of epithelium within the
cords form valve-like folds (Fig. 1 .3d) A mem-
branous covering consisting of conjunctival and
canalicular epithelium remains over the puncta,
Fig. 1.2 Macroscopic view of a prepared right canaliculi,
and a covering consisting of nasal and nasolacri-
lacrimal sac, and duct in situ (From Thale et al. [1 5 ])
mal epithelium (called membrane of Hasner)
remains over the nasolacrimal duct outlet.
Ectoderm from the fl oor of the groove becomes Punctal membranes open at full- term; however,
entrapped between the prominences and the membrane of Hasner remains imperforate in
detaches from the surface ectoderm as a cord of up to 70 % of newborns. This usually opens
epithelium. within the fi rst month but may remain imperfo-
T he inferior part of this cord forms the naso- rate for a longer time, resulting in epiphora or
lacrimal duct while the superior one will enlarge mucopurulent discharge.