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CC BY-NC-ND 4.0 · Arch Plast Surg 2022; 49(02): 195-199
DOI: 10.1055/s-0042-1744407
Pediatric/Craniomilofacial/Head & Neck
Case Report

Prophylactic Intraoperative Nasolacrimal Duct Intubation in Surgical Treatment of Facial Fractures—Is There a Role?

Ryan Liang Wei Teoh
1   Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
,
Pei Yuan Fong
1   Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
,
Elijah Zhengyang Cai
1   Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
2   Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore, Singapore
,
Yan Lin Yap
1   Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
2   Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore, Singapore
,
Eileen Chor Hoong Hing
1   Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
2   Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore, Singapore
,
Han Jing Lee
2   Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore, Singapore
,
Vigneswaran Nallathamby
2   Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore, Singapore
,
Wei Chen Ong
1   Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
2   Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore, Singapore
,
Jane Lim
1   Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
2   Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore, Singapore
,
Gangadhara Sundar
3   Division of Oculoplastic Surgery, Department of Ophthalmology, National University Health System, Singapore, Singapore
,
Thiam Chye Lim
1   Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
2   Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore, Singapore
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Funding None.
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Abstract

Nasolacrimal duct (NLD) damage is associated in the majority of type II and III naso-orbito-ethmoid (NOE) fractures.1 Our study aims to investigate the efficacy and safety of prophylactic NLD intubation in the setting of facial fractures, by comparing incidence of postoperative epiphora and wound infection. A retrospective matched control study was conducted on all patients with surgically treated facial fractures from 2008 to 2013 (n = 280) (IRB ref number: DSRB 2013/01198). Patients with the following fracture types were included: NOE (n = 16), frontal sinus (n = 2), Le Fort II/III (n = 8), and > 1 type (n = 48). All patients in this study were included with the intention to treat. The study group comprised patients who were intubated, while the control group patients were not intubated. Each group had 37 patients matched for age, gender, fracture type, and injury type. A single oculoplastic surgeon skilled in lacrimal surgery performed the procedure for all intubated patients. Patients with more severe and complex facial fractures were intubated with bicanalicular Crawford stents. Postoperative epiphora and infective complications (both facial wound and dacryocystitis) were assessed at 1, 3, 6, and 12 months. There was no significant difference in incidence of either postoperative epiphora (p = 0.152) or wound infection (p = 0.556) comparing both groups. Reduced incidence of postoperative epiphora in the study group is statistically not significant and does not support the need for prophylactic intubation. If radiographic evidence of NLD disruption or regurgitation seen on syringing on the NLD intraoperatively is present, intubation is safe and efficacious only if performed by an expert.

Keywords

nasolacrimal - facial - fractures - orbit - epiphora

Author Contributions

All authors were involved in the conceptualization, methodology, and project administration aspects of this study. T.C.L. and G.S. were involved in direct supervision of this study. R.L.W.T., P.Y.F., and T.C.L. were involved in the writing of the original draft, review, and editing of this study's manuscript.


Ethical Approval

The authors declare that this is an independent original study (IRB ref number: DSRB 2013/01198).




Publication History

Article published online:
06 April 2022

© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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