Analysis Of The Effect Of Nasal Uncinate Process On Endoscopic Dacryocystorhinostomy

Purpose:Chronic dacryocystitis is a common clinical diseases caused by obstruction or narrowing of the nasolacrimal ducts,which can lead to serious complications such as keratitis,orbital cellulitis and even blindness.The lacrimal duct is closely adjacent to the lateral wall of the nasal cavity,and studies have shown that structural abnormalities of the nasal cavity are risk factors for the development of chronic dacryocystitis,of which inferior turbinate hypertrophy and nasal septal deviation are the two main types.With the development of nasal-eye related disease,(Endoscopic Dacryocystorhinostomy,En-DCR)is considered to be the ideal procedure for the treatment of chronic dacryocystitisathome both at home and abroad.The key to the success of the procedure is the accurate positioning of the lacrimal fossa on the lateral wall of the nasal cavity under the nasal endoscope and the accurate removal of the bone to expose the lacrimal sac.The uncinate process are closely related to the anatomy of the lacrimal fossa.This study aims to investigate the role of structural abnormalities of nasal uncinate process on the development of chronic dacryocystitis and further analyze the effect of unciformectomy on the prognosis of En-DCR,to provide a reference for the diagnosis and treatment of chronic dacryocystitis and further provide a basis for the clinical promotion of En-DCR surgery.Methods:By selecting 107 patients who visited Qingdao Municipal Hospital between May2021 and May 2022 and underwent CT examination of the eye or nose as study subjects,among which patients with non-chronic dacryocystitis(55 patients)were the control group and patients with unilateral chronic dacryocystitis clearly diagnosed by the specialist(52 patients)were the study group,The correlation between the anatomical variation of the uncinate process and chronic dacryocystitis was studied by analyzing the type of cephalic attachment of the uncinate process and the presence of deviation,hypertrophy,pneumatization or absence of the uncinate process.A total of 50 patients in the study group(chronic dacryocystitis)had hypertrophy and deviation of the uncinate process,49 of whom underwent En-DCR after conservative treatment failed,while the other one refused surgery,which was divided into groups A and B according to the randomized number table method.Group A(26 patients)underwent En-DCR with unciformectomy,and group B(23 patients)underwent En-DCR alone,patients undergo regular postoperative nasal endoscopy and tear duct irrigation.The clinical outcomes of the two groups were observed,as well as nasal adhesions,scarring,and granulation at the anastomosis.The collected data were analyzed using SPSS 25.0 statistical software.Results:1.There was no statistical difference in age and sex between the study group(n=52)and the control group(n=55)(P>0.05);in the analysis of the relationship between the type of attachment of the head end of the uncinate process and chronic dacryocystitis,there was no significant difference in the incidence of paper-like plate type,sieve top type,bifurcation type,and middle turbinate type between the patients in the study group and the control group(P>0.05);when comparing the height and angle of the uncinate process and the ethmoid infundibulum in the two groups,the average uncinate process angle in the study group was(123.60±15.08°),and the average uncinate process angle in the control group was(136.89±12.59°).There was a difference in the incidence of uncinate process angle in the two groups(P<0.05),while the uncinate process height and the ethmoid infundibulum width were not significantly different in the two groups(p>0.05).In the relationship between other anatomical variations of the uncinate process and chronic dacryocystitis,there were significant differences in the two groups in terms of uncinate process deviation and hypertrophy(p<0.05),while there were no significant differences in the incidence of uncinate process pneumatization between the two groups(p > 0.05).2.At 6-month follow-up after En-DCR,the postoperative efficacy was 92.3%(24/26)in group A(En-DCR with unciformectomy)and 82.6%(19/23)in group B(En-DCR alone),with no significant difference in clinical efficacy between the two groups(p>0.05);in group A(En-DCR with unciformectomy),postoperative complications such as nasal adhesions,granulation,and scarring at the anastomosis occurred in 11.5%(3/26)compared with 39.1%(9/23)in group B(preserved uncinate process),and there was a significant difference in the incidence of postoperative complications between the two groups(P<0.05).Conclusion:1.Abnormalities of nasal uncinate process are closely related to the development of chronic dacryocystitis,and uncinate process hypertrophy and deviation are two of the main types.2.En-DCR with unciformectomy can effectively expand the nasal space and reduce the incidence of postoperative complications such as anastomotic stoma adhesions,granulation tissue and scar proliferation,and the operation is safe and effective,which is worthy of clinical promotion and application.