Nasolacrimal Duct Obstruction after Zygoma Fracture Reduction with Inferior Orbital Margin Fixation

Abstract

Injuries of lacrimal passages are common in accidental midfacial trauma and surgical trauma like Caldwell-Luc operation, orbital decompression and orbital floor repair. Reduction and fixation of midfacial fractures have not been reported till now to cause any injury to the lacrimal passages. We present a case of fracture zygoma who developed epiphora after reduction and fixation of the inferior orbital margin by a miniplate.

Two cases of nasolacrimal duct obstruction operated by endoscopic dacryocystorhinostomy after orbital fracture reconstruction with an implant

“…In a previous report, a patient who experienced epiphora after facial fracture treatment reported that removal of the implant alone caused the symptoms to improve. 7 However, in our case (case 2) we needed to perform EnDCR because implant removal did not improve the NLDO. If the lacrimal sac was only compressed, removal of the implant alone may have improved the NLDO; however, if the lacrimal sac was damaged, we suspected that it would be difficult to improve the drainage system due to chronic inflammation.…”

“…The cause of NLDO after orbital floor fracture reconstruction may be attributed to improper implant positioning or chronic inflammation caused by the implant. 5 , 6 , 7 The most commonly reported treatment strategy is a combination of ExDCR and implant removal. 5 , 6 , 8 In case 1, we only performed EnDCR without implant removal.…”

“… 2 , 3 , 4 Rare cases of NLDO after orbital floor fracture reconstruction have been reported, and the reason for these cases is thought to be inflammation associated with trauma or mechanical obstruction due to the implant. 5 , 6 , 7 There are reports of treatment strategies for this problem, such as removal of the inserted implant, external dacryocystorhinostomy, or transconjunctival dacryocystorhinostomy. 5 , 6 , 8 However, the optimal treatment strategy remains controversial.…”

Lacrimal Drainage Systems Injured During Repair of Orbital Fractures

“…Impaired lacrimal drainage may result from large or improperly placed orbital implants 1 , this complication having been reported with many materials (Table 2). 1–10 It is a commonly held belief that materials used for orbital wall repair should be very rigid, whereas the material only needs to provide soft-tissue support until the newly formed fibrin layer around the implant becomes a sheet of dense collagen; this, in practical terms, means that a thin and slightly flexible sheet, such as 1–1.5 mm porous polythene, is readily shaped and more than adequate to support the repositioned orbital tissues. Even with an extended lower fornix incision, the placement of rigid and bulky implants is difficult and carries a significant risk of damage to neighboring orbital structures; custom-manufactured implants are not only very expensive but are rigid, rather bulky, and can fail to epithelialize (as in Case 4).…”

“…1–3 Damage to the lacrimal outflow system during orbital fracture repair is infrequent and most published cases have been attributed to implant migration or misplacement. 1–10…”