title: Posttraumatic obstruction of lacrimal pathways: a retrospective analysis of 58 consecutive naso-orbitoethmoid fractures.
abstract: Posttraumatic dacryostenosis represent a troublesome sequela for patients who have sustained centrofacial trauma and can determine complexity in diagnosis and treatment. This article, based on a retrospective analysis of 58 patients with naso-orbitoethmoidal (NOE) trauma, reports the incidence of posttraumatic dacryostenosis and the evolution of such impairments in consideration of fracture type. Experience in diagnosis and treatment is illustrated, and surgical outcomes 6 months after external dacryocystorhinostomy (DCR) are reported. Posttraumatic epiphora was observed in 27 patients with NOE fractures (46.5%). In 10 cases, temporary epiphora was encountered and spontaneous recovery of lacrimal drainage within 5 months was observed. In the remaining 17 cases, permanent epiphora was registered and a frequent association with delayed treatment of facial fracture repair or bone loss in the lacrimal district was found. Surgical reconstruction of lacrimal pathways was performed 6 months after primary surgery, with external DCRs in all 17 patients with epiphora and the presence of nasolacrimal duct obstruction observed with dacryocystorhinography. External DCR with a large rhinostomy achieved a success rate of 94% in the reconstruction of lacrimal drainage. Such a technique proved to be effective in the treatment of posttraumatic dacryostenosis, although patients considered the temporary presence of external scars and stenting material to be a major problem.
authors.affiliation: Department of Maxillo-facial Surgery, Policlinic Sant'Andrea, II Faculty of Medicine and Surgery, La Sapienza University, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Becelli
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Renzi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mannino
authors.forename: Giulio
authors.initials: G
authors.lastname: Cerulli
authors.forename: Giorgio
authors.initials: G
authors.lastname: Iannetti
mesh_terms: D000328:Adult; D000368:Aged; D003608:Dacryocystorhinostomy / Q000379:methods*; D005004:Ethmoid Bone / Q000293:injuries; D005260:Female; D006801:Humans; D007767:Lacrimal Duct Obstruction / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009295:Nasal Bone / Q000293:injuries; D009917:Orbital Fractures / Q000150:complications; D012189:Retrospective Studies; D012887:Skull Fractures / Q000150:complications*; D013666:Tears / Q000378:metabolism