MPL exposed by blunt dissection and then cut to expose anterior lacrimal crest
and periosteum elevated.
Widths of the LF in its upper, middle, and lower third: Distance between the anterior lacrimal crest
and the posterior lacrimal crest
in the upper, middle, and lower third of the LF (Fig.
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.
Using the Kerrisonrounguer the bone forming the lacrimal crest
was nibbled and removed.
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.
After detaching medial canthal ligament, the periosteum over the lacrimal crest
is divided to enter lacrimal fossa.
Relating the position of the posterior lacrimal crest
with the uninvolved side, we then took a hand drill with a 1.5-mm drill bit and fashioned a through-and-through tunnel that exited near the superior portion of the lacrimal fossa on the contralateral side.
For male skulls, when different skull classes were compared, there was significant difference in the distance between nasomaxillary suture and anterior lacrimal crest
. For female skulls, when different skull classes were compared, there was significant difference in the length of nasomaxillary suture (lateral height of the nose) and width of nasal bones (width of nasal dorsum).
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.
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
. Blunt dissection is carried on to reach the periosteum.
Periosteal incision was done anterior to the anterior lacrimal crest
, and elevated with a periosteal elevator, to expose the lacrimal sac fossa.