PREOPERATIVE RADIOLOGICAL EXAMINATION OF PATIENTS WITH CHRONIC DACRYOCYSTITIS
Abstract
The aim of our study was to develop a method for determining the topographic and anatomical relationship of the lacrimal sac with the surrounding structures and to evaluate its effectiveness in planning and performing endonasal endoscopic dacryocystorhinostomy (EEDCR). The study group (1st group) consisted of 45 who underwent EEDCR according to our technique, the comparison group (2nd) included 36 patients who, after performing EEDCR developed by us, into the dacryorinostoma zone a polyvinyl chloride conductor was installed. In the control group (3rd) included 28 patients who EEDCR performed by the the generally accepted technique. To assess the informativeness of computed tomography (CT) techniques of the lacrimal ducts (LD) and the possibility of effective use of the obtained CT data, patients of the 1st and 2nd groups were divided into 2 subgroups: 1A and 2A were included patients whom CT LD was performed according to the developed method, and patients of subgroups 1B and 2B – according to the traditional algorithm. Hyperpneumatization of agger nasi cells was detected in 14.7% of the examined, inflammatory pathology in the paranasal sinuses – in 38.5% (p> 0.05). The lacrimal fossa was located at the level of the anterior end of the middle turbinate (MT) in 39.4% of cases, anteriorly in 32.1%, and posteriorly in 14.7%. In 13.8% of cases, it was difficult to determine the ratio of the lacrimal fossa to the anterior end of the MT, these cases were in subgroups 1B, 2B and in group № 3 (p <0.05). Visualization of the surgical field according to the Andre P. Boezaart scale (1995) 1-2 degrees in subgroups 1A and 2A was more than 90% of patients in subgroups 1B and 2B – less than 50%, and in group 3 – in 25% of patients (p <0.05). Thus, the anatomical and topographic features of the LD must be determined and taken into account in the surgical treatment and observation of patients with chronic dacryocystitis. The developed technique of CT with contrasting LD is more effective than the traditional one, and the performance of surgical intervention when using it is sparing.
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