A surprise in the lacrimal sac

Abstract

To present a case with recurrent dacryocystitis as an unusual complication of medial orbital wall fracture repair with cartilage tissue graft. A 20-year-old male had facial trauma and underwent surgery to reconstruct right medial orbital wall fracture. During follow–up, he presented with continuous epiphora, mucopurulent discharge from the right eye. A thorough history taking indicated that medial orbital fracture was reconstructed with postauricular cartilage. We planned a standard external dacryocystorhinostomy (DCR). During the creation of lacrimal sac flaps, hard tissue was noted in the lacrimal sac. This tissue was excised and sent for pathological examination. The pathological examination revealed cartilage tissue. There were no further ipsilateral symptoms or complications after DCR. In patients with lacrimal system injury related to orbital wall fracture, iatrogenic foreign bodies in the lacrimal sac should be considered in patients with recurrent dacryocystitis who had reconstructive surgery for facial and orbital trauma.

Lacrimal Duct Obstruction Caused by Nasomaxillary Fracture: A Retrospective Analysis of Consecutive 12 Patients by Computed Tomographic Dacryocystography

“…Several causes of iatrogenic lacrimal obstruction are reported to be lacrimal plugs, the complication of transcutaneous medial canthal incision, and cartilage grafts for medial orbital wall fracture. [11][12][13] However, there were no reports regarding screwing during ORIF. For avoiding this complication, surgeons must pay attention to the anatomical relationship between the fracture lines and NLS.…”

“…The unsuitable screw insertion was speculated to give the obstruction of lacrimal pathway. Several causes of iatrogenic lacrimal obstruction are reported to be lacrimal plugs, the complication of transcutaneous medial canthal incision, and cartilage grafts for medial orbital wall fracture 11–13 . However, there were no reports regarding screwing during ORIF.…”

Lacrimal Drainage Systems Injured During Repair of Orbital Fractures

“…Impaired lacrimal drainage may result from large or improperly placed orbital implants 1 , this complication having been reported with many materials (Table 2). 1–10 It is a commonly held belief that materials used for orbital wall repair should be very rigid, whereas the material only needs to provide soft-tissue support until the newly formed fibrin layer around the implant becomes a sheet of dense collagen; this, in practical terms, means that a thin and slightly flexible sheet, such as 1–1.5 mm porous polythene, is readily shaped and more than adequate to support the repositioned orbital tissues. Even with an extended lower fornix incision, the placement of rigid and bulky implants is difficult and carries a significant risk of damage to neighboring orbital structures; custom-manufactured implants are not only very expensive but are rigid, rather bulky, and can fail to epithelialize (as in Case 4).…”

“…1–3 Damage to the lacrimal outflow system during orbital fracture repair is infrequent and most published cases have been attributed to implant migration or misplacement. 1–10…”

Retained Herrick Plug

“…A careful history in any patient presenting with dacryocystitis or epiphora can raise one's suspicion of a retained iatrogenic foreign body. In patients with a history of reconstructive surgery of the medial orbital wall, retained postauricular cartilage [ 4 ] and a silastic sheet [ 5 ] have been detected in the lacrimal sac. In patients with a history of intubation with silicone stents or DCR, pieces of silicone tubing [ 6 ], a Griffiths' collar button stent used to maintain the nasal ostium [ 7 ], and retained gauze [ 8 ] have been identified in the lacrimal system.…”