Normal Endoscopic Anatomy
A thorough knowledge of a normal endoscopic anatomy is essential for lacrimal interventions. It not only helps the surgeon identify any deviations from the normal and pathologies but prepares the ground for transnasal surgical interventions. The nares or
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Normal Endoscopic Anatomy
A thorough knowledge of a normal endoscopic anatomy is essential for lacrimal interventions. It not only helps the surgeon identify any deviations from the normal and pathologies but prepares the ground for transnasal surgical interventions. The nares or nostrils are the two openings into the nasal cavity [1]. The nasal septum divides the nasal cavity into two sides. The nasal septum comprises cartilage anteriorly (quadrilateral/septal cartilage) and bone posteriorly (vertical plate of the ethmoid bone posterosuperiorly and vomer bone posteroinferiorly). The lateral wall of the nose is a complex structure [1–5]. There are three or four paired nasal turbinates with a corresponding meatus under each turbinate. The middle turbinate is the most prominent landmark and is a part of ethmoid bone and is attached to the lateral wall by its axilla. Lacrimal sac usually lies anterior to the axilla of the middle turbinate. The inferior turbinate is the largest turbinate and occupies the lower third of the lateral nasal wall. It arises from the medial wall of the maxillary sinus. Its anterior tip is located 1.5–2.0 cm inside the nasal space in adults, and the nasolacrimal duct empties into the inferior meatus [1–5]. Examination technique of endoscopy involves three passes of which the first two are important for a lacrimal surgeon. During the first pass, the endoscope is introduced along the floor of the nasal cavity, between the inferior turbinate and the septum, toward the choana. This first pass allows examination of the inferior part of the nasal cavity including the inferior meatus where the nasolacrimal duct drains and the nasal septum, as well as the nasopharynx and Eustachian tube openings. The endoscope is then withdrawn and gently reinserted for the second pass between the middle and inferior turbinate, to examine the middle meatus. It is during the second pass that the lateral nasal wall is inspected including the maxillary line and attachment of the middle turbinate.
References 1. Witterick IJ, Hurwitz JJ. Anatomy of the nose and sinuses. In: Hurwits JJ, editor. The lacrimal system. Philadelphia, PA: Lippincott-Raven; 1996. p. 31–7. 2. Cottle MH. The structure and function of the nasal vestibule. In: Maurice H, Cottle MD, Barelli PA, editors. Rhinology. Philadelphia, PA: American Rhinologic Society; 1987. p. 74–86. 3. Woo KI, Maeng HS, Kim YD. Characteristics of intranasal structures for endonasal dacryocystorhinostomy in Asians. Am J Ophthalmol. 2011;152:491–8. 4. Yung MW, Logan BM. The anatomy of the lacrimal bone at the lateral wall of the nose: its significance to the lacrimal surgeon. Clin Otolaryngol Allied Sci. 1999;24:262–5. 5. Ohnogi J. Endoscopic observation of inferior aperture of the nasolacrimal duct. Jpn J Clin Ophthalmol. 2001;55:650–4.
© Springer Nature Singapore Pte Ltd. 2018 M.J. Ali, Atlas of Lacrimal Drainage Disorders, https://doi.org/10.1007/978-981-10-5616-1_6
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6 Normal Endoscopic Anatomy
Fig. 6.1 A set of endoscopic telescopes with variable diameters a
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