Management of the lacrimal system during maxillectomy.
BACKGROUND
Oncologic resection of the maxilla requires management of the nasolacrimal sac/duct system (NLS). A variety of techniques may be used: simple transection, transection with transcanalicular stenting, drilling of the entire nasolacrimal bony canal to the inferior meatus with mobilization of an intact NLS, marsupialization of the NLS with or without stenting, and simple transection with routine delayed dacryocystorhinostomy (DCR) for symptomatic epiphora. Rates of prolonged epiphora range from 13 to 63%.


OBJECTIVE
We present our approach to NLS management during maxillectomy, and our rates of epiphora.


METHODS
Review of 212 consecutive patients who underwent transection of the NLS during medial maxillectomy, complete maxillectomy with preservation of orbital contents, suprastructure maxillectomy, or maxillectomy as part of anterior craniofacial resection. Patients with primary NLS tumors were excluded. Prolonged epiphora is defined as persistent if it lasts more than 6 months.


METHODS
After exposure of the anterior maxillary wall and inferior and medial orbital rim, a high-speed drill and Kerrison rongeurs are used to remove the anterior wall of the nasolacrimal canal. The NLS is transected 12-15 mm distal to the periorbita and removed from the canal. Two 4-6-mm opposing incisions are made at the distal duct. Two semicircular flaps are everted, folded, and sutured to the proximal sac or periorbita. A transcanalicular stent is not placed.


RESULTS
Two-hundred twelve patients underwent the above-mentioned procedure. Four patients (1.9%) developed prolonged epiphora, which required delayed DCR.


CONCLUSIONS
Marsupialization of the NLS without stenting provided us with an acceptably low rate of prolonged epiphora.
Habib
Ramez
R
Dept. of Otolaryngology, SUNY Downstate Medical Center and Continuum Cancer Centers, 134 Atlantic Ave., Brooklyn, NY 11201, USA.
Har-El
Gady
G
D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007765:Lacrimal Apparatus / Q000601:surgery*; D007766:Lacrimal Apparatus Diseases / Q000209:etiology*; D008297:Male; D008437:Maxilla / Q000601:surgery*; D009301:Nasolacrimal Duct / Q000601:surgery; D019647:Oral Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome