Injury to the Lacrimal Apparatus After Endoscopic Sinus Surgery: Surgical Implications From Active Transport Dacryocystography

Abstract

In order to evaluate the lacrimal drainage system injury after functional endoscopic sinus surgery, surgical records and postoperative active transport dacryocystography imaging of 31 patients were analyzed. Presence of the lacrimal bone dehiscence and no passage of the contrast material into the inferior meatus were noted as the signs of injury to the lacrimal canal on active transport dacryocystography. Bony dehiscence was detected in 53.2% of the operated sides but 20% of the nonoperated sides. No passage of the contrast material into the inferior meatus was observed in 14.9% of the operated sides. There were no cases of epiphora postoperatively. The lacrimal drainage system injury was more frequently observed on the left sides operated. We conclude that lacrimal drainage system injury might occur in various extents during functional endoscopic sinus surgery. However, it does not necessarily result in postoperative epiphora. Performing the middle meatal antrostomy in posteroinferior direction, and uncinectomy with backbiting forceps or a shaver might help in reducing the lacrimal injury. Active transport dacryocystography can be adopted as an alternative diagnostic tool in detection of the lacrimal injury.

Surgical anatomy of the nasolacrimal duct on the lateral nasal wall as revealed by serial dissections

“…A good familiarity with the surgical anatomical relationships is therefore important to avoid inadvertent injury during endoscopic sinus surgery. The complication of injury to the NLD following endoscopic sinus surgery has been Mean/SD 21.9 ± 2.03 3.9 ± 0.88 24.6 ± 3.56 13.7 ± 3.15 14.3 ± 2.05 reported to be 0.3-1.7% (Kennedy et al 1987;Serdahl et al 1990;Bolger et al 1992;Unlu et al 2001). In addition, during endoscopic DSR, the mucosa on the lateral nasal wall anterior to the uncinate process should be removed in order to expose the bone covering of the NLD.…”

Topography of the nasolacrimal duct on the lateral nasal wall in Koreans

“…Injury to the lacrimal system has been reported with facial trauma, craniofacial surgery, nasal osteotomies during rhinoplasty, and nasal antrostomies [4,8,24]. Craniofacial surgery, rhinoplasty, and facial trauma may involve the lacrimal sac or canaliculi [7].…”

“…This technique allows direct visualization, evaluation, and treatment of intranasal abnormalities [22]. The nasolacrimal apparatus is intimately associated with the lateral nasal wall and may be readily approached using an endoscopic technique, which minimizes the functional interference with the physiological action of the lacrimal apparatus [24]. Defining the position of the nasolacrimal sac and duct during this surgical procedure is important.…”

Asymptomatic Lacrimal Flow Abnormalities in Patients with Septal Deviations and Turbinate Hypertrophy

“…These techniques have been used to study the effect of lateral osteotomies, external and endoscopic paranasal sinus surgery, and dacryocystorhinostomy on the lacrimal apparatus [5][6][7][8][9]. In the current study, we used these techniques to evaluate the incidence of outflow alterations among patients who had septal deviations with or without turbinate hypertrophy but asymptomatic for epiphora and postoperative changes occurring after corrective rhinoseptoplasty.…”