The role of lacrimal intubation in the management of facial trauma and tumor resection.
BACKGROUND
Lacrimal drainage dysfunction is a common and problematic consequence of any pathologic process that interferes with the physiology or continuity of the lacrimal drainage apparatus. The literature widely documents several reliable, safe, and consistently well-tolerated techniques of nasolacrimal intubation for the repair of lacrimal system dysfunction; however, the role and the timing of such intubation in primary surgery involving the regional anatomy of the lacrimal system remain controversial. The authors evaluated the role of lacrimal intubation as a therapeutic and prophylactic procedure in complex primary surgery for trauma, tumor, and chronic infection of the lacrimal drainage system.


METHODS
Sixty-one cases of either unilateral or bilateral silicone intubation of the lacrimal drainage system in 54 patients were analyzed retrospectively with respect to diagnosis, indication for intubation (therapeutic or prophylactic), and clinical outcome. Final long-term patency of the system after tube removal was assessed by the absence of epiphora and positive Jones primary dye test.


RESULTS
Lacrimal intubation as part of the primary repair of facial trauma, tumor resection, and relief of lacrimal system obstruction resulted in a patent, functional lacrimal drainage system in all 61 cases, with no associated morbidity. The risks of diagnostic manipulation at the time of surgery were avoided.


CONCLUSIONS
This series demonstrates that prophylactic intubation of the lacrimal system in any trauma or tumor resection near or around the region in addition to those that directly involve these systems should be considered, as the risks of silicone intubation in such cases are relatively negligible compared with the morbidity and nuisance associated with postoperative epiphora and/or recurrent dacryocystitis. Concomitant nasolacrimal intubation in conjunction with the repair of complex midfacial fractures or tumor extirpation is a safe and effective means of ensuring the establishment of a patent, functional drainage system in the absence of direct lacrimal system involvement.
Spinelli
Henry M
HM
Weill Medical College of Cornell University, New York, NY 10021, USA. hmspinelli@aol.com
Shapiro
Michael D
MD
Wei
Lisa L
LL
Elahi
Ebrahim
E
Hirmand
Haideh
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000150:complications / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003608:Dacryocystorhinostomy; D005134:Eye Neoplasms / Q000150:complications / Q000601:surgery*; D005151:Facial Injuries / Q000150:complications / Q000601:surgery*; D005153:Facial Neoplasms / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007440:Intubation; D007765:Lacrimal Apparatus / Q000033:anatomy & histology; D007766:Lacrimal Apparatus Diseases / Q000601:surgery*; D007767:Lacrimal Duct Obstruction / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome