title: Intraoperative lacrimal intubation to prevent epiphora as a result of injury to the nasolacrimal system after fracture of the naso-orbitoethmoid complex.
abstract: Treatment of fracture of the naso-orbitoethmoid (NOE) complex is difficult. There are not only aesthetic issues but also functional consequences related to the lacrimal system. Because prophylactic lacrimal intubation for such fractures remains controversial, we have assessed the effectiveness of intraoperative lacrimal intubation to prevent epiphora as a result of such injuries. Thirteen patients diagnosed with craniomaxillofacial fractures including fractures of the NOE complex were included in the study; 10 had unilateral fractures and 3 bilateral. Computed tomography (CT) showed all patients had displaced fragments that had the potential to damage the lacrimal duct. In 7 patients the fractures included the canthal region and in 6 they did not. All patients were treated by open reduction and internal fixation under general anaesthesia, followed by intraoperative lacrimal intubation unilaterally or bilaterally as required. Lacrimal intubation with a silicone tube was successful in all 13 patients (16 sides). The tube was removed 2-9 months (mean 3.8) postoperatively and no subsequent epiphora were seen during follow-up (mean (3-29 months) 11.3 months). Lacrimal intubation for at least 2 months may prevent epiphora caused by injury to the nasolacrimal system after fractures of the NOE complex.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan. Electronic address: iwai104oams@yahoo.co.jp.
authors.forename: Toshinori
authors.initials: T
authors.lastname: Iwai
authors.forename: Kazunori
authors.initials: K
authors.lastname: Yasumura
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yabuki
authors.forename: Susumu
authors.initials: S
authors.lastname: Omura
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Matsui
authors.forename: Shinji
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Ryo
authors.initials: R
authors.lastname: Fujimaki
authors.forename: Makiko
authors.initials: M
authors.lastname: Okubo
authors.forename: Iwai
authors.initials: I
authors.lastname: Tohnai
authors.forename: Jiro
authors.initials: J
authors.lastname: Maegawa
mesh_terms: D000293:Adolescent; D000328:Adult; D005004:Ethmoid Bone / Q000293:injuries / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D007440:Intubation / Q000379:methods*; D007766:Lacrimal Apparatus Diseases / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009295:Nasal Bone / Q000293:injuries / Q000601:surgery*; D009301:Nasolacrimal Duct / Q000293:injuries* / Q000601:surgery; D009917:Orbital Fractures / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome