Dacryologic complications of rhinosurgery: a case series analysis

Abstract

BACKGROUND: The number of iatrogenic complications, including dacryologic ones, inevitably increases with the active development of rhino-sinus surgery and the increase in the number of nasal procedures.

AIM: The aim was to evaluate the anatomical causes and the type of structural damage of the vertical part of the lacrimal ducts in cases of dacryocystitis after nasal and sinus surgery.

MATERIALS AND METHODS: The study included a retrospective analysis of 38 case reports of patients with chronic secondary dacryocystitis after nasal and sinus surgery.

RESULTS: Based on the data analysis, patients were divided into three comparable groups according to the level of lacrimal duct damage. Lacrimal duct obstruction was found at the level of the lacrimal sac in group 1 (7 cases), at the level of upper and middle part of nasolacrimal duct in group 2 (21 cases), at the level of lower third of the nasolacrimal duct in group 3 (10 cases). The relationship between the level of damage and the type of previous surgical procedure was evaluated. Retrograde dissection of the uncinate process during endoscopic middle meatal antrostomy was found to be the most common cause of lacrimal duct obstruction (12 cases, 31.58%). Persistent obstruction of the vertical part of the nasal passages was observed after anterior ethmoidectomy, maxillary sinus surgery with partial or total medial wall dissection, inferior turbinate plasty, inferior turbinate mucosal flap, and lateral osteotomy in rhinoplasty.

CONCLUSIONS: The results obtained require further study in a larger, more representative sample of patients.

Keywords

lacrimal ducts / complications / sinusotomy / rhinoplasty / endoscopic endonasal dacryocystorhinostomy

References

[1] Hosemann W, Draf C. Danger points, complications and medico-legal aspects in endoscopic sinus surgery. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2013;12:Doc06. doi: 10.3205/cto000098

[2] Hosemann W., Draf C. Danger points, complications and medico-legal aspects in endoscopic sinus surgery // GMS Curr Top Otorhinolaryngol Head Neck Surg. 2013. Vol. 12. P. Doc06. doi: 10.3205/cto000098

[3] Siedek V, Pilzweger E, Betz C, et al. Complications in endonasal sinus surgery: a 5-year retrospective study of 2,596 patients. Eur Arch Otorhinolaryngol. 2013;270:141–148. doi: 10.1007/s00405-012-1973-z

[4] Siedek V., Pilzweger E., Betz C., et al. Complications in endonasal sinus surgery: a 5-year retrospective study of 2,596 patients // Eur Arch Otorhinolaryngol. 2013. Vol. 270. P. 141–148. doi: 10.1007/s00405-012-1973-z

[5] Wormald PJ. Powered endonasal dacryocystorhinostomy. Larynoscope. 2002;112:69–72. doi: 10.1097/00005537-200201000-00013

[6] Wormald P.J. Powered endonasal dacryocystorhinostomy // Larynoscope. 2002. Vol. 112. P. 69–72. doi: 10.1097/00005537-200201000-00013

[7] Duvanova ED, Danilov SS, Grusha YO. Ophthalmic complications of endoscopic sinus surgery. Russian Annals of Ophthalmology. 2022;138(2):108–113. EDN: XAQCJL doi: 10.17116/oftalma2022138021108

[8] Дуванова Е.Д., Данилов С.С., Груша Я.О. Офтальмологические осложнения эндоскопических операций на придаточных пазухах носа // Вестник офтальмологии. 2022. Т. 138, № 2. С. 108–113. EDN: XAQCJL doi: 10.17116/oftalma2022138021108

[9] Nguyen TH, Venturelli N, Espinoza S, et al. Persistent epiphora after endonasal ENT surgery: CT dacryography findings. J Fr Ophtalmol. 2022;45(3):306–313. doi: 10.1016/j.jfo.2021.12.010

[10] Nguyen T.H., Venturelli N., Espinoza S., et al. Persistent epiphora after endonasal ENT surgery: CT dacryography findings // J Fr Ophtalmol. 2022. Vol. 45, N 3. P. 306–313. doi: 10.1016/j.jfo.2021.12.010

[11] Serdahl CL, Berries CE, Chole RA. Nasolacrimal duct obstruction after endoscopic sinus surgery. Arch Ophthalmol. 1990;108:391–392. doi: 10.1001/archopht.1990.01070050089038

[12] Serdahl C.L., Berries C.E., Chole R.A. Nasolacrimal duct obstruction after endoscopic sinus surgery // Arch Ophthalmol. 1990. Vol. 108. P. 391–392. doi: 10.1001/archopht.1990.01070050089038

[13] Mukherjee B, Gudkar AI, Nair AG, et al. Iatrogenic nasolacrimal duct obstruction after adnexal intervention: An avoidable consequence. Oman J Ophthalmol. 2021;14(3):157–161. doi: 10.4103/ojo.ojo_462_20

[14] Mukherjee B., Gudkar A.I., Nair A.G., et al. Iatrogenic nasolacrimal duct obstruction after adnexal intervention: An avoidable consequence // Oman J Ophthalmol. 2021. Vol. 14, N 3. P. 157–161. doi: 10.4103/ojo.ojo_462_20

[15] Gupta N. Endoscopic Dacryocystorhinostomy. Springer Singapore; 2021. doi: 10.1007/978-981-15-8112-0

[16] Gupta N. Endoscopic Dacryocystorhinostomy. Springer Singapore, 2021. doi: 10.1007/978-981-15-8112-0

[17] Kakizaki H. Anatomy, physiology, and immunology of the lacrimal system. In: Ali MJ, editor. Principles and Practice of Lacrimal Surgery. 2nd edition. Springer Singapore; 2018. P. 16–33.

[18] Kakizaki H. Anatomy, physiology, and immunology of the lacrimal system. В кн.: Ali M.J., editor. Principles and Practice of Lacrimal Surgery. 2nd edition. Springer Singapore, 2018. P. 16–33.

[19] Takahashi Y, Nakamura Y, Nakano T, et al. The narrowest part of the bony nasolacrimal canal: an anatomical study. Ophthalmic Plast Reconstr Surg. 2013;29:318–322. doi: 10.1097/IOP.0b013e31828de0b0

[20] Takahashi Y., Nakamura Y., Nakano T., et al. The narrowest part of the bony nasolacrimal canal: an anatomical study // Ophthalmic Plast Reconstr Surg. 2013. Vol. 29. P. 318–322. doi: 10.1097/IOP.0b013e31828de0b0

[21] Sarber KM, O’Connor PD, Doellman MS, et al. Surgical relationship of the nasolacrimal system to the maxillary line: Performing safe mega antrostomy. Allergy Rhinol (Providence). 2015;6(3):158–161. doi: 10.2500/ar.2015.6.0138

[22] Sarber K.M., O’Connor P.D., Doellman M.S., et al. Surgical relationship of the nasolacrimal system to the maxillary line: Performing safe mega antrostomy // Allergy Rhinol (Providence). 2015. Vol. 6, N 3. P. 158–161. doi: 10.2500/ar.2015.6.0138

[23] Burkat CN, Lucarelli MJ. Anatomy of the lacrimal system. In: Cohen AJ, Brazzo B, eds. The lacrimal system: diagnosis, management, and surgery. New York: Springer; 2006.

[24] Burkat C.N., Lucarelli M.J. Anatomy of the lacrimal system. In: Cohen A.J., Brazzo B., eds. The lacrimal system: diagnosis, management, and surgery. New York: Springer, 2006.

[25] Ali MJ, Murphy J, Wormald PJ, Psaltis AJ. Bony nasolacrimal duct dehiscence in functional endoscopic sinus surgery: radiological study and discussion of surgical implications. J Laryngol Otol. 2015;129 Suppl 3:S35–40. doi: 10.1017/S0022215115000778

[26] Ali M.J., Murphy J., Wormald P.J., Psaltis A.J. Bony nasolacrimal duct dehiscence in functional endoscopic sinus surgery: radiological study and discussion of surgical implications // J Laryngol Otol. 2015. Vol. 129 Suppl 3. P. S35–40. doi: 10.1017/S0022215115000778

[27] Unlü HH, Gövsa F, Mutlu C, et al. Anatomical guidelines for intranasal surgery of the lacrimal drainage system. Rhinology. 1997;35(1):11–15.

[28] Unlü H.H., Gövsa F., Mutlu C., et al. Anatomical guidelines for intranasal surgery of the lacrimal drainage system // Rhinology. 1997. Vol. 35, N 1. P. 11–15.

[29] Fasina O, Ogbole GI. CT assessment of nasolacrimal canal in a black African population. Ophthalmic Plast Reconstr Surg. 2013;29(3):231–233. doi: 10.1097/IOP.0b013e3182873d2e

[30] Fasina O., Ogbole G.I. CT assessment of nasolacrimal canal in a black African population // Ophthalmic Plast Reconstr Surg. 2013. Vol. 29, N 3. P. 231–233. doi: 10.1097/IOP.0b013e3182873d2e

[31] McCormick A, Sloan B. The diameter of nasolacrimal canal measured by computed tomography: gender and racial differences. Clin Exp Ophthalmol. 2009;37(4):357–361. doi: 10.1111/j.1442-9071.2009.02042.x

[32] McCormick A., Sloan B. The diameter of nasolacrimal canal measured by computed tomography: gender and racial differences // Clin Exp Ophthalmol. 2009. Vol. 37, N 4. P. 357–361. doi: 10.1111/j.1442-9071.2009.02042.x

[33] Unlu HH, Goktan C, Aslan A, Tarhan S. Injury to the lacrimal apparatus after endoscopic sinus surgery: surgical implications from active transport dacryocystography. Otolaryngol Head Neck Surg. 2001;124(3):308–312. doi: 10.1067/mhn.2001.112433

[34] Unlu H.H., Goktan C., Aslan A., Tarhan S. Injury to the lacrimal apparatus after endoscopic sinus surgery: surgical implications from active transport dacryocystography // Otolaryngol Head Neck Surg. 2001. Vol. 124, N 3. P. 308–312. doi: 10.1067/mhn.2001.112433

[35] Imre A, Imre SS, Pinar E, et al. Transection of nasolacrimal duct in endoscopic medial maxillectomy: implication on epiphora. J Craniofac Surg. 2015;26(7):e616–619. doi: 10.1097/SCS.0000000000002115

[36] Imre A., Imre S.S., Pinar E., et al. Transection of nasolacrimal duct in endoscopic medial maxillectomy: implication on epiphora // J Craniofac Surg. 2015. Vol. 26, N 7. P. e616–619. doi: 10.1097/SCS.0000000000002115

[37] Karpishchenko SA, Beldovskaya NY, Baranskaya SV, Karpov AA. Ophthalmic comlications of functional endoscopic sinus surgery. Ophthalmology reports. 2017;10(1):87–92. EDN: YNAGTR doi: 10.17816/OV1087-92

[38] Карпищенко С.А., Белдовская Н.Ю., Баранская С.В., Карпов А.А. Офтальмологические осложнения функциональной эндоскопической хирургии околоносовых пазух // Офтальмологические ведомости. 2017. Т. 10, № 1. С. 87–92. EDN: YNAGTR doi: 10.17816/OV1087-92

[39] Liang N, Qu J, Huang Q, Zhou B. Prelacrimal recess approach for maxillary sinus inverted papilloma: a 15-year experience from a single center. Eur Arch Otorhinolaryngol. 2024;281(9):4763–4771. doi: 10.1007/s00405-024-08551-x

[40] Liang N., Qu J., Huang Q., Zhou B. Prelacrimal recess approach for maxillary sinus inverted papilloma: a 15-year experience from a single center // Eur Arch Otorhinolaryngol. 2024. Vol. 281, N 9. P. 4763–4771. doi: 10.1007/s00405-024-08551-x

[41] Yeguas-Ramírez L, Santamaría-Gadea A, Vaca-González M, et al. Minimally Anterior Medial Maxillary Approach (MAMMA): a novel technique for a wide access to the maxillary sinus. Eur Arch Otorhinolaryngol. 2024;281(4):1799–1806. doi: 10.1007/s00405-023-08335-9

[42] Yeguas-Ramírez L., Santamaría-Gadea A., Vaca-González M., et al. Minimally Anterior Medial Maxillary Approach (MAMMA): a novel technique for a wide access to the maxillary sinus // Eur Arch Otorhinolaryngol. 2024. Vol. 281, N 4. P. 1799–1806. doi: 10.1007/s00405-023-08335-9

[43] Koo HB, Lee JH. Effect of anterior maxillary wall shape on ease of prelacrimal recess approach among Asians and Westerners. Eur Arch Otorhinolaryngol. 2023;280(5):2317–2322. doi: 10.1007/s00405-022-07768-y

[44] Koo H.B., Lee J.H. Effect of anterior maxillary wall shape on ease of prelacrimal recess approach among Asians and Westerners // Eur Arch Otorhinolaryngol. 2023. Vol. 280, N 5. P. 2317–2322. doi: 10.1007/s00405-022-07768-y

[45] Jamshidian Tehrani M, Asadi Khameneh E, Veisi A. lacrimal drainage system problems after rhinoplasty. Aesthetic Plast Surg. 2021;45(1):255–260. doi: 10.1007/s00266-020-01929-2

[46] Jamshidian Tehrani M., Asadi Khameneh E., Veisi A. lacrimal drainage system problems after rhinoplasty // Aesthetic Plast Surg. 2021. Vol. 45, N 1. P. 255–260. doi: 10.1007/s00266-020-01929-2

[47] Çetin YS, Akin R. Dacryocystitis with skin defects secondary to septorhinoplasty. J Craniofac Surg. 2022;33(1):e69–e71. doi: 10.1097/SCS.0000000000007953

[48] Çetin Y.S., Akin R. Dacryocystitis with skin defects secondary to septorhinoplasty // J Craniofac Surg. 2022. Vol. 33, N 1. P. e69–e71. doi: 10.1097/SCS.0000000000007953

[49] Atkova EL, Krakhovetskiy NN, Yartsev VD, Mazurova YuV. Meatoplasty — an effective method for surgical treatment of patients with nasolacrimal duct ostium stenosis. Russian bulletin of otorhinolaryngology. 2019;84(4):28–32. EDN: WPWMCI doi: 10.17116/otorino20198404128

[50] Атькова Е.Л., Краховецкий Н.Н., Ярцев В.Д., Мазурова Ю.В. Меатопластика — эффективный способ хирургического лечения пациентов со стенозом устья носослезного протока // Вестник оториноларингологии. 2019. Т. 84, № 4. С. 28–32. EDN: WPWMCI doi: 10.17116/otorino20198404128

[51] Nowak R, Nowak-Gospodarowicz I, Rekas M, Ali MJ. Lacrimal sac reconstruction using a nasal mucosal graft. Ophthalmic Plast Reconstr Surg. 2022;38(5):e150–e152. doi: 10.1097/IOP.0000000000002189

[52] Nowak R., Nowak-Gospodarowicz I., Rekas M., Ali M.J. Lacrimal sac reconstruction using a nasal mucosal graft // Ophthalmic Plast Reconstr Surg. 2022. Vol. 38, N 5. P. e150–e152. doi: 10.1097/IOP.0000000000002189

[53] Sadeghi N, Joshi A. Management of the nasolacrimal system during trans nasal endoscopic medial maxillectomy. Am J Rhinol Allergy. 2012;26(2):e85–88. doi: 10.2500/ajra.2012.26.3737

[54] Sadeghi N., Joshi A. Management of the nasolacrimal system during trans nasal endoscopic medial maxillectomy // Am J Rhinol Allergy. 2012. Vol. 26, N 2. P. e85–88. doi: 10.2500/ajra.2012.26.3737

[55] Agarwal A, Naik M, Ali MJ, Bothra N. The role of CT-DCG in hardware — associated secondary acquired lacrimal duct obstruction: SALDO update study — (SUP) — Paper III. Am J Ophthalmol Case Rep. 2024;34:102026. doi: 10.1016/j.ajoc.2024.102026

[56] Agarwal A., Naik M., Ali M.J., Bothra N. The role of CT-DCG in hardware — associated secondary acquired lacrimal duct obstruction: SALDO update study — (SUP) — Paper III // Am J Ophthalmol Case Rep. 2024. Vol. 34. P. 102026. doi: 10.1016/j.ajoc.2024.102026

RIGHTS & PERMISSIONS

Eco-Vector