3D CT-DCG reconstruction-informed inferior turbinate dacryocystorhinostomy in post-traumatic chronic dacryocystitis with displaced lacrimal sac.

BACKGROUND

Conventional endoscopic dacryocystorhinostomy (DCR) relies on the middle turbinate as a landmark for localizing the lacrimal sac. However, in post-traumatic lacrimal sac displacement, the middle turbinate approach often fails, and blind exploration may cause excessive surgical trauma.

OBJECTIVE

To evaluate the feasibility and effectiveness of a three-dimensional (3D) CT-dacryocystography (CT-DCG)-guided inferior turbinate approach, utilizing the distal nasolacrimal duct as an anatomical anchor for retrograde exploration of the displaced lacrimal sac in traumatic dacryocystitis.

METHODS

We conducted a consecutive case series. Preoperative 3D CT-DCG was used to reconstruct the displacement trajectory of the lacrimal sac. Through the inferior turbinate approach, the distal nasolacrimal duct was exposed and traced retrogradely to the sac, followed by endoscopic nasolacrimal sac anastomosis. Primary outcomes included lacrimal patency (irrigation and dye tests), symptom scores, and postoperative complications.

RESULTS

Both patients with post-traumatic lacrimal sac displacement underwent successful endoscopic dacryocystorhinostomy via the inferior turbinate approach with CT-DCG guidance. Complete lacrimal drainage patency was achieved at the first attempt, as confirmed by irrigation and dye testing. During follow-up (up to 6 months post surgery), patients remained symptom-free with no recurrence of obstruction. Intraoperative trauma and bleeding were minimal, and no severe complications such as cerebrospinal fluid leakage or orbital injury occurred.

CONCLUSIONS

The CT-DCG-assisted inferior turbinate approach provides a precise, anatomically informed pathway for managing post-traumatic lacrimal sac displacement. By reducing blind dissection and tissue trauma, this method achieves high success rates with low surgical morbidity. These findings suggest that it may serve as a viable alternative approach for complex or refractory cases of traumatic dacryocystitis, warranting further validation in larger prospective studies.

CLINICAL TRIAL NUMBER: Not applicable.