Gruss J S, Hurwitz J J, Nik N A, Kassel E E
Br J Plast Surg. 1985 Jan;38(1):116-21. doi: 10.1016/0007-1226(85)90098-0.
A detailed review of forty-six patients with severe naso-orbital-ethmoid injury confirms that naso-lacrimal system injury is less common than originally suspected. Post-operative epiphora is more frequently due to eyelid malposition than naso-lacrimal obstruction. Eight patients (17.4%) required eventual dacryocystorhinostomy. Three out of five patients (60%), treated with closed reduction and external splint fixation, needed dacryocystorhinostomy. This treatment predisposes to external compression of the naso-lacrimal system by malpositioned bone fragments and segments. Open reduction and internal fixation of all fractures provides optimal repair and minimizes the incidence of post-operative epiphora. During fracture repair, the naso-lacrimal sac should be identified, but not probed or intubated unless obviously lacerated. The upper lacrimal pathway is protected by the medial canthal ligament. Obstruction usually occurs in the bony naso-lacrimal canal. Telecanthus invariably accompanies severe naso-orbital-ethmoid injuries and subsequent naso-lacrimal obstruction. Dacryocystography is useful in the investigation of naso-lacrimal function. When dacryocystorhinostomy is necessary, it should be performed at least 3 months after the primary repair.
对46例严重鼻眶筛骨损伤患者的详细回顾证实，鼻泪系统损伤比最初怀疑的要少见。术后溢泪更多是由于眼睑位置异常而非鼻泪管阻塞。8例患者（17.4%）最终需要进行泪囊鼻腔吻合术。在5例接受闭合复位和外部夹板固定治疗的患者中，有3例（60%）需要进行泪囊鼻腔吻合术。这种治疗方式易因骨碎片和骨段位置异常而导致鼻泪系统受到外部压迫。所有骨折进行切开复位和内固定可提供最佳修复，并将术后溢泪的发生率降至最低。在骨折修复过程中，应识别鼻泪囊，但除非明显撕裂，否则不应进行探查或插管。上泪道受内眦韧带保护。阻塞通常发生在骨性鼻泪管。内眦间距增宽总是伴随着严重的鼻眶筛骨损伤及随后的鼻泪管阻塞。泪囊造影对鼻泪功能的检查有用。当需要进行泪囊鼻腔吻合术时，应在初次修复后至少3个月进行。
