title: Traumatic sinolacrimocutaneous fistula managed with endonasal dacryocystorhinostomy and anterior ethmoidectomy.
abstract: A 31-year-old man with epiphora and mucous discharge from a traumatic lacrimal fistula underwent a computed tomographic dacryocystogram, revealing a fistula extending from the anterior ethmoid air cells through the lacrimal sac to the overlying skin with coexisting nasolacrimal duct obstruction. Endoscopic dacryocystorhinostomy enabled complete marsupialization of the lacrimal sac and agger nasi air cell, removing the tract between these structures. Simultaneous probing of the common canaliculus and fistula tract under direct visualization allowed the identification of the internal fistula origin in relation to the internal ostium on the lateral sac wall. The fistula was excised with a trephine over a guide wire via an external approach. Use of the endoscopic technique for excision of acquired lacrimal fistulas may be especially helpful in cases with coexisting nasolacrimal duct obstruction where the fistula extends to the sinus cavity or suspected foreign bodies.
authors.affiliation: South Australian Institute of Ophthalmology, Department of Ophthalmology and Visual Sciences, Adelaide University, Adelaide, South Australia, Australia.
authors.forename: Pari N
authors.initials: PN
authors.lastname: Shams
authors.forename: Dinesh
authors.initials: D
authors.lastname: Selva
mesh_terms: D000328:Adult; D017577:Cutaneous Fistula / Q000000981:diagnostic imaging / Q000601:surgery*; D003608:Dacryocystorhinostomy; D004724:Endoscopy; D005005:Ethmoid Sinus / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D015807:Eye Injuries, Penetrating / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007765:Lacrimal Apparatus / Q000293:injuries*; D007766:Lacrimal Apparatus Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D010254:Paranasal Sinus Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed