Epiphora Following Rhinoplasty and Caldwell-Luc Procedures

Abstract

SUMMARY Cosmetic rhinoplasty and maxillary sinus surgery are rare causes of lacrimal obstruction. The lacrimal sac is quite vulnerable to damage by the lateral osteotomy of the rhinoplasty. While obstruction from such damage usually resolves in three months, these three cases illustrate the risk of persistent obstruction, particularly in complicated cases. The nasoantral window in the Caldwell-Luc may damage the distal lacrimal opening if it is placed too high, or made too large. Occasionally, the duct will extend more anterior and inferior and be quite vulnerable to damage by the nasal antrostomy.

Dacryocystitis With Skin Defects Secondary to Septorhinoplasty

“…The authors reported that lacrimal sac injury are more likely to occur after complicated rhinoplasties, particularly in the presence of scarring and fibrosis caused by previous surgery or injury, and suggested that in such cases, surgery seems mandatory to obtain a permanent solution. 8 In our patient, acute infection of the left lacrimal system did not result from the scarring of the lacrimal system or deep and careless lateral osteotomy. On the other hand, although the acute infection in the left lacrimal system did not cause any injury to the nasolacrimal system, severe edema formation and inflammation around the nasolacrimal duct caused obstruction in the nasolacrimal duct, resulting in impaired drainage as well as abscess formation in the nasolacrimal duct, sac, and medial canthal region.…”

Surgical and Anatomic Consideration in Endoscopic Dacryocystorhinostomy of a Patient with Damaged Sinonasal Anatomy Post–Caldwell-Luc Surgery: A Case Report

“…Only four cases of persistent NLDO post-CL procedure have been described, all of which were reported before 1991. In these cases, epiphora developed shortly after the surgery, usually within one week, resulting from iatrogenic injury to the opening of the nasolacrimal duct during inferior meatus antrostomy [18][19][20]. However, in the present case, epiphora developed more than 40 years after CL surgery.…”

“…Earlier literature suggested that external DCR is the procedure of choice for persistent NLDO post-CL procedure [18][19][20]. In this case, endo-DCR was performed, as it provides an excellent visualization of the intranasal structure and better cosmetic results.…”