Effect Of Uncinate Process Structure On Dacryocystosinostomy

Objective: A discussion of the effect of uncinate process morphology on dacryocystorhinostomy.Method: A study on patients having chronic dacryocystitis and demanding surgical intervention was carried out from May 2021 to May 2022.All the patients’ were coming to outpatient service of the ophthalmology department at our hospital.Computer Tomography(CT)combined with iohexol contrast agent was performed on the dacryocyst of the patients’ involved eye.Patients were grouped as per whethe-r the uncinate process remained morphologically normal.The effect of uncinate process structure on the intrao-perative and prognosis of dacryocystosinostom-y is compared and analysed.Results:(1)Patients in both groups received nasal endoscopic dacryocystorhinostomy.Among those 42 cases,23(54.76%)were found to have abnormal uncinate process,including 9(21.43%)cases of inwardly deviated uncinate process,6(14.29%)cases of hyperplastic uncinate process,5(11.90%)cases of o-utwardly deviated uncinate process and 3(7.14%)cases of uncinate process pneumatization.(2)A comparative analysis was performed on such data of research subjects from both groups interms of their age,sex,involved eye and course of the disease.Results indicate patients in both groups are not significantly different in such general data.(3)The fossae sacci lacrimalis was(2.85±0.44)mm thick in the front upper bone substance and(0.04 ± 0.03)mm thick in the rear lower bone substance(t=43.68,P=0.000,P<0.01).According to the findings here,the fossae sacci lacrimalis’ front upper part is significantly thicker than the rear lower part in bone substance.(4)Patients in both the control group and the experimental group were paid with a follow-up visit before the operation and 1 month,2 months,3 months and 6 months,respectively,after the operation.Lacrimal passage irrigation was applied during follow-up visits.The effective rate and cure rate were assessed using partial clearance and complete clearance.The effective rate in both groups displays a stable tendency at different timings,being always over 80%.As the time goes,the effective rate gradually declines.A statistical analysis suggests both groups are not significantly different in effective rate.As for cure rate,it drops in both groups with the time,but the fall more dramatic in the experimental group than the control group.The fall in the first two months appears to be especially significant in the experimental group;by contrast,it remains steady in the control group.(5)The operation lasted averagely(60.42±8.69)min in the experimental group and(49.04±11.55)min in the control group.A comparison of two groups in operating hours indicates significant difference(P<0.01).(6)Complications were recorded 1 month,2 months,3 months and 6 months,respectively,after the operation.As the results indicate,in the experimental group,granulation slowly increases and dry eye develops with in those 6 months.A statistical analysis of those two groups generates no significant difference.In the control group,both narrowness and blocking degree at the anastomotic stoma slowly worsens and reaches the fastest growth in the 6th month.By comparison,the experimental group witnesses an even quicker growth in both narrowness and blocking degree at the anastomotic stoma as well as a significantly higher number of affected cases.Conclusion: Abnormal uncinate process structure are closely associated with the genesis and development of chronic dacryocystitis.Excision of morphologically abnormal uncinate process could affect the progression and prognosis of dacryocystorhinostomy as well as operation duration,post-operative comfort and cure rate to some degree.However,no statistical difference has been found between the excision and not of the abnormal structure in preoperative complications,intraoperative bleeding,operative efficiency and postoperative complications.Therefore,it is worth promoting excision of dysmorphic uncinate process during chronic dacryocystitis treatment with dacryocystorhinostomy.On the other hand,this also puts forward higher requirements for surgeons,because they should be especially familiar with nose-eye-related anatomical structures,such as the uncinate process and its adjacent structures.This study may shed some light on the prognosis prediction by clinical surgeons before implementing the operation.