Document Detail

Management of the lacrimal system during maxillectomy.
MedLine Citation:
PMID:  15706983     Owner:  NLM     Status:  MEDLINE    
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%. OBJECTIVES: We present our approach to NLS management during maxillectomy, and our rates of epiphora. STUDY DESIGN: 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.
Ramez Habib; Gady Har-El
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of rhinology     Volume:  18     ISSN:  1050-6586     ISO Abbreviation:  Am J Rhinol     Publication Date:    2004 Nov-Dec
Date Detail:
Created Date:  2005-02-14     Completed Date:  2005-05-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8807268     Medline TA:  Am J Rhinol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  367-70     Citation Subset:  IM    
Dept. of Otolaryngology, SUNY Downstate Medical Center and Continuum Cancer Centers, 134 Atlantic Ave., Brooklyn, NY 11201, USA.
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MeSH Terms
Follow-Up Studies
Lacrimal Apparatus / surgery*
Lacrimal Apparatus Diseases / etiology*
Maxilla / surgery*
Nasolacrimal Duct / surgery
Oral Surgical Procedures / adverse effects*,  methods*
Retrospective Studies
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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