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J. M. Joseph, C. I. Zoumalan, R. D. Lisman, D. Howard; Evaluation of the Canalicular System: An Anatomic Study. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4832.
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It is frequently stated in the literature that 90% of individuals have a common canaliculus that enters the lacrimal sac, while the remaining 10% have an upper and lower canaliculus that enter the lacrimal sac separately. To our knowledge no prior study has evaluated this through direct anatomical dissection of the human lacrimal drainage system. The purpose of our study is to investigate the frequency of a common canaliculus with direct visualization using a novel technique of cadaveric dissection.
10 preserved cadavers were dissected to allow direct visualization of the canalicular entrance(s) to the lumen of the lacrimal sac. Cadavers were excluded from the study if there was osteotomy evidence of prior dacryocystorhinostomy (DCR) or canalicular obstruction noted on probing. The dissection was achieved first with exposure of the lacrimal sac with a classic external DCR incision followed by blunt dissection to expose the sac in the lacrimal fossa. The upper and lower puncta were dilated with a punctal dilator. A lacrimal cannula was then used to inject surgical lubricant to reinflate the lacrimal sac, which is found to be shrunken secondary to post mortem changes and the preservation process. The medial canthal tendon was then incised allowing for better exposure. The lacrimal sac was then incised at its medial most location with a curved blade and opened to expose. Lacrimal probes were then inserted into the superior and inferior canaliculi and their entrance to the lacrimal sac was directly visualized.
10 cadavers (20 lacrimal systems) were explored using the technique described above. Each system studied thus far demonstrated a common canaliculus entering the lacrimal sac.
The preliminary data supports the occurence rate of a common canaliculus similar to that which has previously been reported. This novel technique in evaluating the common canalicular entrance into the lacrimal sac will enable better understanding of the lacrimal drainage system in future studies.
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