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Discuss the anatomical features of the extraocular muscles
Published in Nathaniel Knox Cartwright, Petros Carvounis, Short Answer Questions for the MRCOphth Part 1, 2018
Nathaniel Knox Cartwright, Petros Carvounis
Superior oblique originates superior medial to the optic canal. Its long tendon loops over the trochlear pulley in the anteromedial part of the roof of the orbit to insert into the posteromedial part of the sclera on the superior aspect of the globe, behind the equator and at an angle of 54° to the primary position. Inferior oblique originates from the floor of the orbit posterior to the orbital margin and lateral to the nasolacrimal canal. This muscle inserts into the sclera under the cover of the lateral rectus muscle on the posterolateral aspect of the globe at an angle of 55° to the primary position. The oculomotor nerve innervates inferior oblique, the trochlear nerve superior oblique.
Maxilla: LeFort Fracture Patterns
Published in Jeffrey R. Marcus, Detlev Erdmann, Eduardo D. Rodriguez, Essentials of CRANIOMAXILLOFACIAL TRAUMA, 2014
Scott T. Hollenbeck, Detlev Erdmann
The maxilla constitutes the middle third of the face and is formed from two pyramid-shaped bones containing the hollowed space of the maxillary sinus. These paired bones support the maxillary dentition, contribute to the formation of the hard palate, define the floor and lateral wall of the nasal cavity, and form part of the inferior rim, lateral rim, and floor of the orbit. The alveolar process of the maxilla supports eight teeth per side in an adult; the canine roots are the longest and most prominent. At the superior aspect of the maxilla there is a thickening of the bone along the infraorbital rim. The medial extension of the maxilla is the frontal process, which articulates superiorly with the frontal bone, medially with the nasal bone, and posteriorly with the lacrimal bone. The nasolacrimal canal and medial canthal tendon are closely associated with the maxillary frontal process and may be disrupted by fractures through this region. The superior portion of the maxilla forms the anterior and medial aspect of the orbital floor. Laterally, the maxilla articulates with the zygomatic bone to form the lateral orbital wall.
Medical Therapy for Glaucoma
Published in Neil T. Choplin, Carlo E. Traverso, Atlas of Glaucoma, 2014
Jennifer E. Williamson, Janet B. Serle
Topically applied medications leave the eye via the nasolacrimal drainage system and are systemically absorbed when they come into contact with the mucosa in the oral and nasal pharynx. Reducing the amount of drug exiting the eye through the nasolacrimal canal will increase ocular contact time and reduce the probability of systemic side effects.
Radiological findings of orbital blowout fractures: a review
Published in Orbit, 2021
Ma ReginaPaula Valencia, Hidetaka Miyazaki, Makoto Ito, Kunihiro Nishimura, Hirohiko Kakizaki, Yasuhiro Takahashi
The bony elements of the lacrimal passage (the lacrimal sac fossa and bony nasolacrimal canal) can be involved in patients with craniofacial trauma (Figure 3a). A previous study demonstrated that 9.5% of patients with craniofacial trauma had a fracture of the bony lacrimal passage. However, most of them were classified as Le Fort II or III fractures, or naso-orbito-ethmoid complex fracture, and none of them had a pure orbital blowout fracture.21 Another study also reported that none of the 25 patients with bony lacrimal passage fracture had pure orbital blowout fracture.22 In a study from Singapore, a bony nasolacrimal canal fracture has been associated with medial wall and floor fractures and medial and inferior orbital rim fractures because of the anatomical proximity of these structures. Moreover, bony nasolacrimal canal fracture is also related to lateral orbital wall and superior rim fractures, which may reflect severe blunt trauma.14 In our experience, a bony lacrimal system fracture is generally accompanied by an anterior medial orbital wall blowout fracture. As the lacrimal fossa consists of a thick maxillary bone and a thin lacrimal bone,23,24 lacrimal fossa fracture often occurs in the lacrimal bone (Figure 3a). On the other hand, since the bony nasolacrimal canal has a thin wall, any part of the canal can be fractured (Figure 3a). Surgical outcomes are better with confirmation of a fracture site using dacryoendoscope during fracture reduction and lacrimal tube insertion.25
Swinging inferior turbinate approach to the nasolacrimal duct
Published in Orbit, 2020
David S. Curragh, Craig James, Dinesh Selva
A mucosal incision using monopolar diathermy was made just superior to the insertion of the inferior turbinate on the lateral nasal wall, beginning at the root of the uncinate process, at the junction of its horizontal and vertical portions, continuing onto the frontal process of the maxilla (Figure 2c). The incision was carried forward towards the piriform aperture just anterior to the anterior head of the inferior turbinate and brought inferiorly to the floor of the nose. This incision was made down to the bone to facilitate elevation of the inferior turbinate to expose its attachment to the lateral nasal wall (Figure 2d). The inferior turbinate attaches to the lateral wall on its central portion by three process, the lacrimal, ethmoidal and maxillary processes. The lacrimal process, which forms the medial wall of the nasolacrimal canal, was disinserted and the bone medial to the nasolacrimal duct can then be easily removed (Figure 2e) to expose the entire length of the nasolacrimal duct which was distracted medially from its bony canal, leaving the bony medial wall of the maxillary sinus posterior to the nasolacrimal duct in place (Figure 2f).
The Relationship between Primary Acquired Nasolacrimal Duct Obstruction and Gastroesophageal Reflux
Published in Current Eye Research, 2018
Naser Owji, Mohammad Radaei, Behzad Khademi
The results showed a higher rate of GERD amongst female patients with PANDO, which was statistically significant (p value = 0.01). PANDO was more frequent in women than men by a ratio of 3:1.1 Nasolacrimal canal was narrower and elongated in women than men,45,46 and narrower in patients with PANDO.45 Hormonal and immune status of women can precipitate a generalized desquamation in the body, which involves lacrimal drainage system, and can occlude narrower lacrimal canal of women more easily.47 These factors make women’s lacrimal system more vulnerable to occlusion with possible injurious force, such as GERD.