Background Chronic dacryocystitis due to midfacial fracture is complex, and conventional CT dacryocystography cannot clearly and accurately display the bilateral nasolacrimal ducts. Three-plane reconstruction of CT dacryocystography based on the trend of nasolacrimal canal (CT-DCG-TPR-BTNC) can clearly display the detailed structure of the lacrimal duct. Objective To investigate the value of CT-DCG-TPR-BTNC in the diagnosis and treatment of traumatic chronic dacryocystitis caused by midfacial fracture.
Methods A retrospective analysis was performed for the clinical and CT data of 22 patients with traumatic chronic dacryocystitis admitted to the Third Medical Center of Chinese PLA General Hospital from June 2019 to December 2021, and all patients underwent CT-DCG-TPR-BTNC. The influence of midfacial fracture on lacrimal duct obstruction was analyzed, and the consistency in CT-DCG-TPR-BTNC results was validated during surgery.
Results Among the 22 patients, there were 10 male patients (45.5%) and 12 female patients (54.5%), with a mean age of 30.86±12.02 years (range, 6-53 years). All patients were diagnosed with traumatic chronic dacryocystitis, with a mean medical history of 37.32±52.95 months (range, 3-180 months). CT-DCG-TPR-BTNC showed that all patients had midfacial fracture and the resulting nasolacrimal duct fracture. Midfacial fracture included nasal bone fracture (21/22, 95.5%), orbital fracture (19/22, 86.4%), maxillofacial fracture (12/22, 54.5%), and lacrimal sac atrophy (2/22, 9.1%), and there was 1 patient with skull base fracture. All patients underwent modified external dacryocystorhinostomy, and intraoperative findings were consistent with the results of CT-DCG-TPR-BTNC, with a consistency rate of 100%. Artificial nasolacrimal ducts were placed into the bilateral lacrimal ductules for all patients and were then removed at 3-6 months after surgery, and no recurrence was observed after 3-6 months of follow-up.
Conclusion CT-DCG-TPR-BTNC can accurately evaluate the injury of adjacent tissue before surgery, especially bone injury of the nasolacrimal duct and anatomical variation, and assess the degree of injury of the lacrimal fossa and the nasolacrimal duct, which has an important clinical value in guiding the formulation of surgical plan.
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