Kang J Minjy, Kalin-Hajdu Evan, Idowu Oluwatobi O, Vagefi M Reza, Kersten Robert C
Department of Ophthalmology, University of California, San Francisco, CA, USA.
Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada.
Craniomaxillofac Trauma Reconstr. 2020 Mar;13(1):32-37. doi: 10.1177/1943387520906004. Epub 2020 Feb 20.
This article reviews cases of nasolacrimal obstruction (NLO) secondary to maxillofacial hardware placement.
A retrospective review was performed at a single institution from 2012 to 2017 of patients with NLO following maxillofacial reconstruction. The study was approved by the Institutional Review Board of the University of California, San Francisco, adhered to the tenets of the Declaration of Helsinki, and was Health Insurance Portability and Accountability Act compliant. Patients were included if external dacryocystorhinostomy (DCR) confirmed previously placed maxillofacial hardware as the primary contributor to lacrimal outflow obstruction and had at least 3 months of follow-up.
Of 420 patients who underwent external DCR, 6 cases of implant-related NLO were identified. The mean age was 47.3 ± 9.6 years and 66.7% of patients were male. All patients presented with epiphora and 50% also had chronic dacryocystitis. Patients had prior maxillofacial hardware placement for paranasal sinus tumors (66.7%) or facial fractures (33.3%). In addition to external DCR, all patients had revision or removal of implants that were impeding lacrimal outflow by 2 mechanisms: (1) an orbital implant impinging the lacrimal sac or nasolacrimal duct (NLD) and/or (2) maxillofacial screws placed into the bony NLD or nasolacrimal fossa. Five of the 6 patients (83.3%) had complete resolution of symptoms and patency of the nasolacrimal system at their last follow-up visit (range 3-30 months).
NLO secondary to hardware placement, though infrequent, is underreported. Two mechanisms of hardware-induced NLO were encountered in this case series. Specific attention to nasolacrimal anatomy at the time of maxillofacial reconstruction may help minimize implant-induced NLO.
本文回顾了因颌面硬件植入继发鼻泪管阻塞（NLO）的病例。
2012年至2017年在单一机构对颌面重建后发生NLO的患者进行回顾性研究。该研究经加利福尼亚大学旧金山分校机构审查委员会批准，遵循《赫尔辛基宣言》的原则，并符合《健康保险流通与责任法案》。如果经外部泪囊鼻腔造口术（DCR）证实先前植入的颌面硬件是泪液流出阻塞的主要原因且患者至少有3个月的随访，则纳入研究。
在420例行外部DCR的患者中，识别出6例与植入物相关的NLO。平均年龄为47.3±9.6岁，66.7%的患者为男性。所有患者均表现为溢泪，50%的患者还患有慢性泪囊炎。患者先前因鼻窦肿瘤（66.7%）或面部骨折（33.3%）而植入颌面硬件。除了外部DCR外，所有患者均通过以下两种机制对阻碍泪液流出的植入物进行了翻修或取出：（1）眶内植入物压迫泪囊或鼻泪管（NLD）和/或（2）颌面螺钉置入骨性NLD或鼻泪窝。6例患者中有5例（83.3%）在最后一次随访时（随访时间为3至30个月）症状完全缓解，鼻泪系统通畅。
硬件植入继发的NLO虽然不常见，但报告不足。本病例系列中遇到了两种硬件导致NLO的机制。颌面重建时特别注意鼻泪解剖结构可能有助于减少植入物引起的NLO。
