title: Facial asymmetry and nasal septal deviation in acquired nasolacrimal duct obstruction.
abstract: BACKGROUND
  Acquired nasolacrimal duct obstruction is a common disorder affecting adults. Its pathogenesis is not known. We hypothesize that facial and bony asymmetry can contribute to the unilaterality of the nasolacrimal duct obstruction.
  
  
  METHODS
  Retrospective study was done on all patients with acquired nasolacrimal duct obstruction who presented to our practice from January through June 2010. External photographs were obtained. Lacrimal probing and irrigation was used to confirm blockage of the nasolacrimal duct. Nasal endoscopy was performed to visualize the intranasal anatomy and location of the nasal septum.
  
  
  RESULTS
  There were 23 patients who underwent endoscopic dacryocystorhinostomy (11 males, 12 females) for acquired nasolacrimal duct obstruction. Average age was 58 years old (range, 27 to 84 years). Facial photos analysis showed facial asymmetry in 17 patients, with one side being smaller than the other side. This corresponded to the side of the nasolacrimal duct obstruction in 12 out of these 17 patients (p-value 0.03). Nasal endoscopy revealed septal deviation to the side of the nasolacrimal duct obstruction in 21 of the 23 patients, with one having twisted septal deviation. Septoplasty was performed in 10 cases in addition to endoscopic dacryocystorhinostomy.
  
  
  CONCLUSIONS
  Unilateral nasolacrimal duct obstruction appears to occur on the side in which the nasal septum is deviated. There is a trend of nasal septal deviation toward the smaller side of the face. Further prospective studies are needed to clarify the above relationships.
authors.affiliation: Department of Orbital and Plastic Reconstructive Surgery, Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. TabanMD@yahoo.com
authors.forename: Mehryar
authors.initials: M
authors.lastname: Taban
authors.forename: Imran
authors.initials: I
authors.lastname: Jarullazada
authors.forename: Ronald
authors.initials: R
authors.lastname: Mancini
authors.forename: Catherine
authors.initials: C
authors.lastname: Hwang
authors.forename: Robert A
authors.initials: RA
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003608:Dacryocystorhinostomy / Q000379:methods*; D004724:Endoscopy / Q000379:methods; D005146:Facial Asymmetry / Q000209:etiology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007767:Lacrimal Duct Obstruction / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009300:Nasal Septum / Q000002:abnormalities* / Q000601:surgery; D009301:Nasolacrimal Duct / Q000503:physiopathology / Q000601:surgery; D009667:Nose Deformities, Acquired / Q000175:diagnosis / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome