INVITED COMMENTARY

INVITED COMMENTARY Chronic dacryocystitis is a condition seen most common- The different results when comparing nasal indices of ly in women, as confirmed also by the study of Dogan and male and female patients suffering from chronic dacryo- coworkers. It arises from a congenital or aquired stenosis cystitis within this study underlines the difficulty in the of the nasolacrimal canal. Such stenoses are usually the pathophysiological interpretation of the measurements. result of progressive infections from the nasal cavity or Ethnical factors might play an additional role. Observa- the conjunctiva wich spread onto the mucosal surface of tions made in German hospitals suggest that the incidence the nasolacrimal canal. of this condition occurs in a higher percentage of Turkish A predisposing anatomy is likely to increase the risks patients than in German patients [7]. This observation is [1]. supported by investigations which have shown significant The hypothesis that women have a higher incidence of differences in the resistance of nasal air flow in different stenosis has been supported by Schnyder's [6] and ethnic groups [2]. Meller's [3] investigations. Dogan and coworkers confirm In summary, I believe that Dogan and coworkers through the analysis of their careful and detailed measure- have successfully shown in their study interesting and ments of the external nose that women with a chronic da- statistically significant comparison of nasal sizes be- cryocystitis have smaller noses or nasal indices. tween patients with chronic dacryocystitis and healthy They conclude from their observations, that the likeli- controls. However, these findings alone do not allow di- hood for the spread of infections from the nasal mucosa rect pathophysiological conclusions, but raise further in- onto the nasolacrimal canal could be increased because teresting questions about our current understanding of of the smaller size of the nose. This conclusion should the predisposing factors in chronic dacryocystitis. be reconsidered carefully especially in view of the findings in the male patient group examined in the same study, who have shown significantly larger nasal measurements than their healthy controls. It appears thus questionable whether References the size of the external nose correlates directly with the 1. Busse H, Hollwich F (1978) Erkrankungen der ableitenden Trä- size and anatomic relationships found at the end of the na- nenwege and ihre Behandlung. Enke, Stuttgart, p 126 solacrimal canal. The position and size of the inferior con- 2. Canaby El, Bhatia SN (1997) A comparison of nasal resistance in cha can have a separate significant influence on the local white caucasians and blacks. Am J Rhinol 11:73±75 interactions at the end of the nasolacrimal canal. 3. Meller J (1929) Diseases of the lacrimal apparatus. Trans On the other hand, Ruiz-Barranco and coworkers [5] Ophthalmol Soc UK 49:233 4. Mlynsky G (1985) Physikalische und physiologische Unter- suggested that the increased length of the nasolacrimal ca- suchungen zur Erholung der diagnostischen Aussagekraft der nal is a predisposing factor for stenosis. In the same study, Rhinoresistometrie. Medizinische Dissertation der Friedrich- the angle between the nasolacrimal duct and the wall of Schiller-Universität the orbit was found to be a second predisposing factor, 5. Ruiz-Baranco F (1966) Patogenia de las dacrocistitis papel des conducte nasal. Arch Soc Oftal Hisp Am 26:11; ref: Zentral in that the wider angles lead to an easier occlusion of Ges Ophtal 97 (1966/67) 584 the lumen of the canal. 6. Schnyder F (1929) Über familäres Vorkommen resp die Ver- With respect to the pathophysiology, Dogan et al. sug- erbung von Erkrankungen der Tränenwege. Z Augenheilk 44:257 gest further, that small noses might have, at the end of the 7. Weidle E, Personal communication nasolacrimal canal, less negative pressure and therefore a decreased suction effect on the lacrimal fluid in the duct which would therefore stagnate and lead to ascending in- W. Gubisch Department of Plastic fections. and Reconstructive Surgery Such a suction effect seems rather unlikely according to Marienhospital Mlynski [4]. His investigation showed certain nasal pres- Böhleinstrasse 37 sure gradients which influence the air flow but no such D-70199 Stuttgart negative pressure which could lead to a suction effect. Germany http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Plastic Surgery Springer Journals

INVITED COMMENTARY

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Publisher
Springer-Verlag
Copyright
Copyright © 1999 by Springer-Verlag Berlin Heidelberg
Subject
Medicine & Public Health; Plastic Surgery
ISSN
0930-343X
eISSN
1435-0130
D.O.I.
10.1007/PL00020992
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Abstract

Chronic dacryocystitis is a condition seen most common- The different results when comparing nasal indices of ly in women, as confirmed also by the study of Dogan and male and female patients suffering from chronic dacryo- coworkers. It arises from a congenital or aquired stenosis cystitis within this study underlines the difficulty in the of the nasolacrimal canal. Such stenoses are usually the pathophysiological interpretation of the measurements. result of progressive infections from the nasal cavity or Ethnical factors might play an additional role. Observa- the conjunctiva wich spread onto the mucosal surface of tions made in German hospitals suggest that the incidence the nasolacrimal canal. of this condition occurs in a higher percentage of Turkish A predisposing anatomy is likely to increase the risks patients than in German patients [7]. This observation is [1]. supported by investigations which have shown significant The hypothesis that women have a higher incidence of differences in the resistance of nasal air flow in different stenosis has been supported by Schnyder's [6] and ethnic groups [2]. Meller's [3] investigations. Dogan and coworkers confirm In summary, I believe that Dogan and coworkers through the analysis of their careful and detailed measure- have successfully shown in their study interesting and ments of the external nose that women with a chronic da- statistically significant comparison of nasal sizes be- cryocystitis have smaller noses or nasal indices. tween patients with chronic dacryocystitis and healthy They conclude from their observations, that the likeli- controls. However, these findings alone do not allow di- hood for the spread of infections from the nasal mucosa rect pathophysiological conclusions, but raise further in- onto the nasolacrimal canal could be increased because teresting questions about our current understanding of of the smaller size of the nose. This conclusion should the predisposing factors in chronic dacryocystitis. be reconsidered carefully especially in view of the findings in the male patient group examined in the same study, who have shown significantly larger nasal measurements than their healthy controls. It appears thus questionable whether References the size of the external nose correlates directly with the 1. Busse H, Hollwich F (1978) Erkrankungen der ableitenden Trä- size and anatomic relationships found at the end of the na- nenwege and ihre Behandlung. Enke, Stuttgart, p 126 solacrimal canal. The position and size of the inferior con- 2. Canaby El, Bhatia SN (1997) A comparison of nasal resistance in cha can have a separate significant influence on the local white caucasians and blacks. Am J Rhinol 11:73±75 interactions at the end of the nasolacrimal canal. 3. Meller J (1929) Diseases of the lacrimal apparatus. Trans On the other hand, Ruiz-Barranco and coworkers [5] Ophthalmol Soc UK 49:233 4. Mlynsky G (1985) Physikalische und physiologische Unter- suggested that the increased length of the nasolacrimal ca- suchungen zur Erholung der diagnostischen Aussagekraft der nal is a predisposing factor for stenosis. In the same study, Rhinoresistometrie. Medizinische Dissertation der Friedrich- the angle between the nasolacrimal duct and the wall of Schiller-Universität the orbit was found to be a second predisposing factor, 5. Ruiz-Baranco F (1966) Patogenia de las dacrocistitis papel des conducte nasal. Arch Soc Oftal Hisp Am 26:11; ref: Zentral in that the wider angles lead to an easier occlusion of Ges Ophtal 97 (1966/67) 584 the lumen of the canal. 6. Schnyder F (1929) Über familäres Vorkommen resp die Ver- With respect to the pathophysiology, Dogan et al. sug- erbung von Erkrankungen der Tränenwege. Z Augenheilk 44:257 gest further, that small noses might have, at the end of the 7. Weidle E, Personal communication nasolacrimal canal, less negative pressure and therefore a decreased suction effect on the lacrimal fluid in the duct which would therefore stagnate and lead to ascending in- W. Gubisch Department of Plastic fections. and Reconstructive Surgery Such a suction effect seems rather unlikely according to Marienhospital Mlynski [4]. His investigation showed certain nasal pres- Böhleinstrasse 37 sure gradients which influence the air flow but no such D-70199 Stuttgart negative pressure which could lead to a suction effect. Germany

Journal

European Journal of Plastic SurgerySpringer Journals

Published: Feb 8, 1999

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