Cohen Noam A, Antunes Marcelo B, Morgenstern Kenneth E
Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, 5th floor Ravdin Building, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Otolaryngol Clin North Am. 2010 Aug;43(4):781-8. doi: 10.1016/j.otc.2010.04.005.
Due to the proximity of the lacrimal duct and sac to the uncinate process, occult injury to the lacrimal drainage system is common during uncinectomy and maxillary antrostomy. Fortunately, these injuries do not often progress to develop clinical symptoms as most either heal on their own, or drain into the middle meatus. In the event that injury to the lacrimal drainage system does become clinical evident, symptoms will present within the first two weeks following surgery. These symptoms may resolve over the ensuing weeks as the intranasal inflammation resolves. In cases of persistent epiphora, determination of the level of obstruction is critical for proper intervention. This can be achieved with several office-based studies as well as radiographic studies. If the obstruction is in the lacrimal duct, dacryocystorhinostomy is a highly successful surgical procedure. However, complications do occur with inadvertent violation of the orbit and cranial vault the subject of substantial publications while lacrimal duct injury (LDI) following FESS has been relatively neglected.
由于泪道和泪囊与钩突相邻，在钩突切除术和上颌窦造口术期间，泪道引流系统隐匿性损伤很常见。幸运的是，这些损伤通常不会发展为临床症状，因为大多数损伤要么自行愈合，要么引流至中鼻道。如果泪道引流系统损伤确实变得明显，症状将在手术后的头两周内出现。随着鼻内炎症消退，这些症状可能在接下来的几周内得到缓解。对于持续性溢泪的病例，确定梗阻部位对于正确干预至关重要。这可以通过几种门诊检查以及影像学检查来实现。如果梗阻位于泪道，泪囊鼻腔吻合术是一种非常成功的外科手术。然而，确实会出现因意外侵犯眼眶和颅顶而引发并发症的情况，这方面有大量文献报道，而功能性鼻内镜鼻窦手术（FESS）后泪道损伤（LDI）相对受到忽视。
