The nasolacrimal canal is the bony channel connecting the lacrimal fossa in the medial orbit to the inferior meatus of the nasal cavity, through which the nasolacrimal duct descends. It is formed by a groove on the medial wall of the maxillary sinus and a contribution from the lacrimal bone superiorly and the inferior nasal concha inferiorly. It opens into the inferior nasal meatus at the Hasner valve.
The nasolacrimal canal is relevant in lacrimal system obstruction (dacryostenosis) and in nasal and sinus surgery. During medial antrostomy in FESS, the posterior attachment of the inferior turbinate must be respected to avoid injury to the nasolacrimal duct where it enters the inferior meatus. Aggressive resection of the inferior turbinate anteriorly risks the duct. In Le Fort I and total maxillectomy procedures, the nasolacrimal duct is divided and re-anastomosed or stented to prevent post-operative epiphora.
Aggressive resection of the anterior inferior turbinate or medial antrostomy extended too far anteriorly risks injury to the nasolacrimal duct as it enters the inferior meatus at Hasner valve, producing post-operative epiphora that requires DCR to restore lacrimal drainage.
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