Thomas J R, Griner N
Otolaryngol Head Neck Surg. 1986 Mar;94(3):362-7. doi: 10.1177/019459988609400319.
Damage to the lacrimal drainage system is a potentially complicating factor in rhinoplasty utilizing lateral osteotomies. The authors present data from osteotomies performed on a series of fresh cadavers. Following completion of the osteotomies, the lacrimal sac and nasal lacrimal ducts were identified and cannulated. Soft tissue was dissected to demonstrate the osteotomy site. The specimen was inspected to delineate involvement (if any) of the lacrimal duct or sac. The proximity of the osteotomy site to the lacrimal drainage apparatus components was measured in each specimen. Various parameters were observed, including the effect of curved vs. straight osteotomies, guarded vs. unguarded osteotomies, and the effect of various widths of osteotomies. Likewise, the degree of risk to the lacrimal system was evaluated, and the technique of the novice and resident surgeon was compared to that of the experienced rhinoplastic surgeon. A low, curved osteotomy, performed with a sharp osteotome without subperiosteal tunnels, provides the safest maneuver. Lateral osteotomies, properly performed, prove to be an unusual cause of lacrimal drainage dysfunction.
泪道系统损伤是采用外侧截骨术的鼻整形术中一个潜在的复杂因素。作者展示了对一系列新鲜尸体进行截骨术的数据。截骨术完成后，识别并插管泪囊和鼻泪管。解剖软组织以显示截骨部位。检查标本以确定泪道或泪囊是否受累（如有）。测量每个标本中截骨部位与泪道引流装置各组成部分的距离。观察了各种参数，包括弧形截骨与直线截骨的效果、有保护措施的截骨与无保护措施的截骨的效果以及不同宽度截骨的效果。同样，评估了泪道系统的风险程度，并将新手和住院医师的手术技术与经验丰富的鼻整形外科医生的技术进行了比较。使用锋利的骨凿进行低位弧形截骨，不做骨膜下隧道，是最安全的操作方法。正确实施的外侧截骨术被证明是泪道引流功能障碍的罕见原因。
