Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Prophylactic Intraoperative Nasolacrimal Duct Intubation in Surgical Treatment of Facial Fractures-Is There a Role?

  • Teoh, Ryan Liang Wei (Yong Loo Lin School of Medicine, National University of Singapore) ;
  • Fong, Pei Yuan (Yong Loo Lin School of Medicine, National University of Singapore) ;
  • Cai, Elijah Zhengyang (Yong Loo Lin School of Medicine, National University of Singapore) ;
  • Yap, Yan Lin (Yong Loo Lin School of Medicine, National University of Singapore) ;
  • Hing, Eileen Chor Hoong (Yong Loo Lin School of Medicine, National University of Singapore) ;
  • Lee, Han Jing (Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System) ;
  • Nallathamby, Vigneswaran (Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System) ;
  • Ong, Wei Chen (Yong Loo Lin School of Medicine, National University of Singapore) ;
  • Lim, Jane (Yong Loo Lin School of Medicine, National University of Singapore) ;
  • Sundar, Gangadhara (Division of Oculoplastic Surgery, Department of Ophthalmology, National University Health System) ;
  • Lim, Thiam Chye (Yong Loo Lin School of Medicine, National University of Singapore)
  • Published : 2022.03.15
Download PDF
⟨ Previous Next ⟩

Abstract

Nasolacrimal duct (NLD) damage is associated in the majority of type II and III naso-orbito-ethmoid (NOE) fractures. Our study aims to investigate the efficacy and safety of prophylactic NLD intubation in the setting of facial fractures, by comparing incidence of postoperative epiphora and wound infection. A retrospective matched control study was conducted on all patients with surgically treated facial fractures from 2008 to 2013 (n=280) (IRB ref number: DSRB 2013/01198). Patients with the following fracture types were included: NOE (n=16), frontal sinus (n=2), Le Fort II/III (n=8), and > 1 type (n=48). All patients in this study were included with the intention to treat. The study group comprised patients who were intubated, while the control group patients were not intubated. Each group had 37 patients matched for age, gender, fracture type, and injury type. A single oculoplastic surgeon skilled in lacrimal surgery performed the procedure for all intubated patients. Patients with more severe and complex facial fractures were intubated with bicanalicular Crawford stents. Postoperative epiphora and infective complications (both facial wound and dacryocystitis) were assessed at 1, 3, 6, and 12 months. There was no significant difference in incidence of either postoperative epiphora (p=0.152) or wound infection (p=0.556) comparing both groups. Reduced incidence of postoperative epiphora in the study group is statistically not significant and does not support the need for prophylactic intubation. If radiographic evidence of NLD disruption or regurgitation seen on syringing on the NLD intraoperatively is present, intubation is safe and efficacious only if performed by an expert.

Keywords

References

  1. Markowitz BL, Manson PN, Sargent L, et al. Management of the medial canthal tendon in nasoethmoid orbital fractures: the importance of the central fragment in classification and treatment. Plast Reconstr Surg 1991;87(05):843-853 https://doi.org/10.1097/00006534-199105000-00005
  2. Unger JM. Fractures of the nasolacrimal fossa and canal: a CT study of appearance, associated injuries, and significance in 25 patients. Am J Roentgenol 1992;158(06):1321-1324 https://doi.org/10.2214/ajr.158.6.1590134
  3. Stranc MF. The pattern of lacrimal injuries in naso-ethmoid fractures. Br J Plast Surg 1970;23(04):339-346 https://doi.org/10.1016/S0007-1226(70)80072-8
  4. Zapala J, Bartkowski AM, Bartkowski SB. Lacrimal drainage system obstruction: management and results obtained in 70 patients. J Craniomaxillofac Surg 1992;20(04):178-183 https://doi.org/10.1016/S1010-5182(05)80393-2
  5. Janssen AG, Mansour K, Bos JJ, Manoliu RA, Castelijns JA. Abscess of the lacrimal sac due to chronic or subacute dacryocystitis: treatment with temporary stent placement in the nasolacrimal duct. Radiology 2000;215(01):300-304 https://doi.org/10.1148/radiology.215.1.r00mr04300
  6. Becelli R, Renzi G, Mannino G, Cerulli G, Iannetti G. Posttraumatic obstruction of lacrimal pathways: a retrospective analysis of 58 consecutive naso-orbitoethmoid fractures. J Craniofac Surg 2004;15(01):29-33 https://doi.org/10.1097/00001665-200401000-00011
  7. Ali MJ, Gupta H, Honavar SG, Naik MN. Acquired nasolacrimal duct obstructions secondary to naso-orbito-ethmoidal fractures: patterns and outcomes. Ophthal Plast Reconstr Surg 2012;28(04):242-245 https://doi.org/10.1097/IOP.0b013e31823f3266
  8. Espinoza GM, Lueder GT. Outcomes in children with nasolacrimal duct obstruction: significance of persistent symptoms while stents are in place. J AAPOS 2007;11(02):187-188 https://doi.org/10.1016/j.jaapos.2006.07.002
  9. Yazici B, Yazici Z. Final nasolacrimal ostium after external dacryocystorhinostomy. Arch Ophthalmol 2003;121(01):76-80 https://doi.org/10.1001/archopht.121.1.76
  10. Lacrimal Drainage System. Duane's Ophthalmology. Philadelphia: Lippincott: Williams and Wilkins; 2006
  11. Connell PP, Fulcher TP, Chacko E, O' Connor MJ, Moriarty P. Long term follow up of nasolacrimal intubation in adults. Br J Ophthalmol 2006;90(04):435-436 https://doi.org/10.1136/bjo.2005.084590
  12. Becelli R, Renzi G, Mannino G, Cerulli G, Iannetti G. Posttraumatic obstruction of lacrimal pathways: a retrospective analysis of 58 consecutive naso-orbitoethmoid fractures. J Craniofac Surg 2004;15(01):29-33 https://doi.org/10.1097/00001665-200401000-00011
  13. Harris GJ, Fuerste FH. Lacrimal intubation in the primary repair of midfacial fractures. Ophthalmology 1987;94(03):242-247 https://doi.org/10.1016/S0161-6420(87)33466-9
  14. Gruss JS, Hurwitz JJ, Nik NA, Kassel EE. The pattern and incidence of nasolacrimal injury in naso-orbital-ethmoid fractures: the role of delayed assessment and dacryocystorhinostomy. Br J Plast Surg 1985;38(01):116-121 https://doi.org/10.1016/0007-1226(85)90098-0
  15. Iwai T, Yasumura K, Yabuki Y, et al. Intraoperative lacrimal intubation to prevent epiphora as a result of injury to the nasolacrimal system after fracture of the naso-orbitoethmoid complex. Br J Oral Maxillofac Surg 2013;51(07):e165-e168 https://doi.org/10.1016/j.bjoms.2012.07.005
  16. Little C, Mintz S, Ettinger AC. The distal lacrimal ductal system and traumatic epiphora. Int J Oral Maxillofac Surg 1991;20(01):31-35 https://doi.org/10.1016/S0901-5027(05)80691-5
  17. Lee MJ, Khwarg SI, Choung HK, Kim N. Associated factors of functional failure of external dacryocystorhinostomy. Can J Ophthalmol 2014;49(01):40-44 https://doi.org/10.1016/j.jcjo.2013.08.006
  18. Spinelli HM, Shapiro MD, Wei LL, Elahi E, Hirmand H. The role of lacrimal intubation in the management of facial trauma and tumor resection. Plast Reconstr Surg 2005;115(07):1871-1876 https://doi.org/10.1097/01.PRS.0000164687.41948.62