Lacrimal duct obstruction may be due to the following: more than 80% - unknown or idiopathic cause, nasal osteotomies performed in rhinoplasty, mid-facial fractures (Le Fort II, III, NOE), wide inferior meatal antrostomy, congenital deformities, recurrent inflammation, nasal tumors and radiation-induced fibrosis.As a general rule, any trauma which affects the mid-third also puts the naso-lacrimal system at risk. Trauma which is limited to soft tissues may be evaluated by the plastic surgeon or ophthalmologist only. We shall therefore not deal with injuries which involve the proximal portion of the system, that is the lacrimal canaliculi.According to Fonseca, in a series of 337 mid-third fractures, only 0.5% reported a nasolacrimal damage. The nasolacrimal duct and sac lie in a protected area of the facial skeleton. The infrequent occurrence of epiphora following nasal fractures is probably due to the protective effect of the canthal medial ligament which may prevent tearing of the superior lacrimal canals. Although some Authors have described lacrimal duct probing and catheterization during primary fracture treatment, this is non advisable in our experience. It is actually difficult and may be dangerous because of post-traumatic edema and changed anatomy. However most difficulties are encountered in NOE fractures.
展开▼
