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

다국어 초록 (Multilingual Abstract)

Nasolacrimal duct (NLD) damage is associated in the majority of type II and III naso-orbito-ethmoid (NOE) fractures.1 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.

참고문헌 (Reference)

1 Spinelli HM, "The role of lacrimal intubation in the management of facial trauma and tumor resection" 115 (115): 1871-1876, 2005

2 Stranc MF, "The pattern of lacrimal injuries in naso-ethmoid fractures" 23 (23): 339-346, 1970

3 Gruss JS, "The pattern and incidence of nasolacrimal injury in naso-orbital-ethmoid fractures : the role of delayed assessment and dacryocystorhinostomy" 38 (38): 116-121, 1985

4 Little C, "The distal lacrimal ductal system and traumatic epiphora" 20 (20): 31-35, 1991

5 Becelli R, "Posttraumatic obstruction of lacrimal pathways : a retrospective analysis of 58consecutive naso-orbitoethmoid fractures" 15 (15): 29-33, 2004

6 Becelli R, "Posttraumatic obstruction of lacrimal pathways : a retrospective analysis of 58consecutive naso-orbitoethmoid fractures" 15 (15): 29-33, 2004

7 Espinoza GM, "Outcomes in children with nasolacrimal duct obstruction : significance of persistent symptoms while stents are in place" 11 (11): 187-188, 2007

8 Markowitz BL, "Management of the medial canthal tendon in nasoethmoid orbital fractures : the importance of the central fragment in classification and treatment" 87 (87): 843-853, 1991

9 Connell PP, "Long term follow up of nasolacrimal intubation in adults" 90 (90): 435-436, 2006

10 Harris GJ, "Lacrimal intubation in the primary repair of midfacial fractures" 94 (94): 242-247, 1987

11 Zapala J, "Lacrimal drainage system obstruction : management and results obtained in 70 patients" 20 (20): 178-183, 1992

12 Iwai T, "Intraoperative lacrimal intubation to prevent epiphora as a result of injury to the nasolacrimal system after fracture of the naso-orbitoethmoid complex" 51 (51): e165-e168, 2013

13 Unger JM, "Fractures of the nasolacrimal fossa and canal : a CT study of appearance, associated injuries, and significance in 25patients" 158 (158): 1321-1324, 1992

14 Yazici B, "Final nasolacrimal ostium after external dacryocystorhinostomy" 121 (121): 76-80, 2003

15 Lacrimal Drainage System, "Duane’s Ophthalmology" Williams and Wilkins 2006

16 Lee MJ, "Associated factors of functional failure of external dacryocystorhinostomy" 49 (49): 40-44, 2014

17 Ali MJ, "Acquired nasolacrimal duct obstructions secondary to naso-orbito-ethmoidal fractures : patterns and outcomes" 28 (28): 242-245, 2012

18 Janssen AG, "Abscess of the lacrimal sac due to chronic or subacute dacryocystitis : treatment with temporary stent placement in the nasolacrimal duct" 215 (215): 300-304, 2000