gms | German Medical Science

104th DOG Annual Meeting

21. - 24.09.2006, Berlin

Surgical anatomy of the lacrimal fossa – a prospective computed tomodensitometry scan analysis

Meeting Abstract

  • X. Morel - Department of Ophthalmology, Hôtel-Dieu de Paris, Paris, France
  • B. Fayet - Department of Ophthalmology, Hôtel-Dieu de Paris, Paris, France
  • E. Racy - Department of Otolaryngology, Clinique Saint Jean de Dieu, Paris, France
  • M. Assouline - Department of Otolaryngology, Clinique Saint Jean de Dieu, Paris, France
  • M. Zerbib - Cabinet d’Ophtalmologie Breteuil, Paris, France

Deutsche Ophthalmologische Gesellschaft e.V.. 104. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft (DOG). Berlin, 21.-24.09.2006. Düsseldorf, Köln: German Medical Science; 2006. Doc06dogSA.16.01

The electronic version of this article is the complete one and can be found online at:

Published: September 18, 2006

© 2006 Morel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




Purpose: To establish the accurate surgical anatomy of endonasal dacryocystorhinostomy (DCR) based on the radiological analysis of underlying bony structures.


Prospective noncomparative observational case series study.


Fifty-nine patients with complete nasolacrimal stenosis underwent a computed tomodensitometry (CT) scan before endonasal DCR.


High-resolution CT scanning with contrast injection of the lacrimal sac was performed. Image reconstruction was performed to obtain continuous 1.0-mm axial and coronal sections for review.

Main Outcome Measures

Relationship of the lacrimal fossa (LF) to the operculum of the middle turbinate (OMT), the uncinate process (UP), and the frontal recess (FR); symmetry of the right and left anatomies; location of the OMT; position of the most anterior insertion of the UP with respect to 2 main references (the posterior lacrimal crest and the junction between the maxillary and lacrimal bones) on axial sections at 3 different levels (upper, intermediate, and lower of the LF); height of the LF; and distance of the OMT from the lower limit of the LF.


The OMT, the UP, and the FR were adjacent to the LF in 41 (53.2%), 73 (94.8%), and 23 cases (29.9%), respectively. There was a right-left symmetry in 10 of 18 patients (55%). The OMT was always anterior to the junction between the maxillary bone and the lacrimal bone. The UP was more frequently posterior (32.5%) or adjacent (45.5%) to the LF at the lower level, adjacent to the maxillary bone,(55.8%) at the intermediate level, and adjacent to the middle turbinate (61 %) at the upper level. The height of the LF was 12.06±1.93 mm. The OMT vas located 5.96±2.05 mm upward from the lover limit of the LF.


The almost constant overlapping of the UP onto the LF at the level of the common canaliculus indicates that the most effective approach for successful DCR osteotomy is via a submucosal cleavage and résection of the anterior part of the UP. The management of these landmark structures should be an integral part of the endonasal DCR method.