Management of the nasolacrimal system during transnasal endoscopic medial maxillectomy
During transnasal endoscopic medial maxillectomy (TEMM) for sinonasal tumors, the nasolacrimal duct (NLD) is resected as it forms part of the medial wall of the maxillary sinus. This disrupts the nasolacrimal drainage system. To ensure that epiphora does not develop after such resection, an endoscopic dacryocystorhinostomy (DCR) is traditionally performed. This is based primarily on prior experience with open medial maxilloethmoidectomy. It is unclear whether a concurrent DCR during endoscopic medial maxillectomy is necessary, however. This study was designed to compare patients undergoing TEMM with or without concurrent DCR for postoperative patency of the NLD.
This is a prospective cohort study comparing12 patients undergoing TEMM, 5 with concurrent DCR and 7 without, to assess for patency of the NLD system. In the group that underwent a concurrent DCR, a Jones silastic stent was inserted for 2‐3 months. Patients were followed for a minimum of 1 year for assessment of epiphora. The patency of the NLD was judged by clinical and qualitative evidence for epiphora.
None of the patients in either group developed epiphora. All were completely symptom free for epiphora during the follow-up period.
It appears that after TEMM, patients do not develop epiphora, whether or not a concurrent DCR is performed. Hence, a concurrent DCR does not seem necessary during TEMM.
Keywords: DCR; Dacryocystorhinostomy; endonasal surgery; endoscopic medial maxillectomy; epiphora; inverting papilloma; lacrimal pump; lacrimal sac; medial maxillectomy; nasolacrimal duct; sinonasal tumors
Document Type: Research Article
Affiliations: Division of Otolaryngology–Head and Neck Surgery, The George Washington University, Washington, D.C., USA
Publication date: 2012-03-01
- The American Journal of Rhinology & Allergy, is a peer reviewed, scientific publication committed to expanding knowledge and publishing the best clinical and basic research within the fields of Rhinology & Allergy. Its focus is to publish information which contributes to improved quality of care for patients with nasal and sinus disorders. Its primary readership consists of otolaryngologists, allergists, and plastic surgeons. Published material includes peer-reviewed original research, clinical trials and review articles.
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Previously published as American Journal of Rhinology, the journal is indexed in Thomson Reuters Web of Science and Science Citation Index, plus the National Library of Medicine's PubMed service.
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