For all patients, a self-tapping, titanium, low-profile head microscrew was drilled into the solid bone on the posterior aspect of the anterior lacrimal crest at the attachment position of the medial canthal ligament.
Subperiosteal dissection was performed to expose the anterior lacrimal crest area.
The surgery was performed under local anaesthesia; 2% Lignocaine with 1:200000 adrenaline was injected at the junction of the inferior orbital margin with the beginning of the anterior lacrimal crest
and subcutaneously in the medial canthal area.
Because it is generally not possible to effectively palpate the anterior lacrimal crest
in a case of severe nasal bone fracture, an estimate of its position was made, based on the position of the medial canthus.
For male skulls, when different skull classes were compared, there was significant difference in the distance between nasomaxillary suture and anterior lacrimal crest.
at the anterior lacrimal crest (Orts-Llorca and Lavine et al.
The lacrimal fascia is incised 1 mm lateral to the anterior lacrimal crest
and the bony attachment of the medial canthal ligament was divided with a blunt dissector the sac was separated from the lacrimal fossa.
The incision is curvilinear incision of about 10-12 mm in length, 3-4 mm from the medial canthus along the anterior lacrimal crest
After exposing the anterior lacrimal crest
, periosteum was incised with periosteum elevator.
The Toti's procedure is an alternative to DCR surgery in which the medial wall of lacrimal sac is excised, lacrimal fossa and anterior lacrimal crest
7) The procedure entails a skin incision and drilling or rongeuring the bone of the anterior lacrimal crest
and lacrimal sac fossa to reach the lacrimal sac.
A curvilinear incision of 10-15 mm length was made along the anterior lacrimal crest
starting 3 mm above the level of medial palpebral ligament and 3mm medial to medial canthus.