Prophylactic Intraoperative Nasolacrimal Duct Intubation in Surgical Treatment of Facial Fractures—Is There a Role?
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 in...
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| Format: | Article |
| Language: | English |
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Thieme Medical Publishers, Inc.
2022-03-01
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| Series: | Archives of Plastic Surgery |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1744407 |
| _version_ | 1811184984943230976 |
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| author | Ryan Liang Wei Teoh Pei Yuan Fong Elijah Zhengyang Cai Yan Lin Yap Eileen Chor Hoong Hing Han Jing Lee Vigneswaran Nallathamby Wei Chen Ong Jane Lim Gangadhara Sundar Thiam Chye Lim |
| author_facet | Ryan Liang Wei Teoh Pei Yuan Fong Elijah Zhengyang Cai Yan Lin Yap Eileen Chor Hoong Hing Han Jing Lee Vigneswaran Nallathamby Wei Chen Ong Jane Lim Gangadhara Sundar Thiam Chye Lim |
| author_sort | Ryan Liang Wei Teoh |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-11T13:21:43Z |
| format | Article |
| id | doaj.art-ad8d0dd6d92f4aba8c65d8c3699ca755 |
| institution | Directory Open Access Journal |
| issn | 2234-6163 2234-6171 |
| language | English |
| last_indexed | 2024-04-11T13:21:43Z |
| publishDate | 2022-03-01 |
| publisher | Thieme Medical Publishers, Inc. |
| record_format | Article |
| series | Archives of Plastic Surgery |
| spelling | doaj.art-ad8d0dd6d92f4aba8c65d8c3699ca7552022-12-22T04:22:11ZengThieme Medical Publishers, Inc.Archives of Plastic Surgery2234-61632234-61712022-03-01490219519910.1055/s-0042-1744407Prophylactic Intraoperative Nasolacrimal Duct Intubation in Surgical Treatment of Facial Fractures—Is There a Role?Ryan Liang Wei Teoh0Pei Yuan Fong1Elijah Zhengyang Cai2Yan Lin Yap3Eileen Chor Hoong Hing4Han Jing Lee5Vigneswaran Nallathamby6Wei Chen Ong7Jane Lim8Gangadhara Sundar9Thiam Chye Lim10Yong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDivision of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore, SingaporeDivision of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDivision of Oculoplastic Surgery, Department of Ophthalmology, National University Health System, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeNasolacrimal 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.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1744407nasolacrimalfacialfracturesorbitepiphora |
| spellingShingle | Ryan Liang Wei Teoh Pei Yuan Fong Elijah Zhengyang Cai Yan Lin Yap Eileen Chor Hoong Hing Han Jing Lee Vigneswaran Nallathamby Wei Chen Ong Jane Lim Gangadhara Sundar Thiam Chye Lim Prophylactic Intraoperative Nasolacrimal Duct Intubation in Surgical Treatment of Facial Fractures—Is There a Role? Archives of Plastic Surgery nasolacrimal facial fractures orbit epiphora |
| title | Prophylactic Intraoperative Nasolacrimal Duct Intubation in Surgical Treatment of Facial Fractures—Is There a Role? |
| title_full | Prophylactic Intraoperative Nasolacrimal Duct Intubation in Surgical Treatment of Facial Fractures—Is There a Role? |
| title_fullStr | Prophylactic Intraoperative Nasolacrimal Duct Intubation in Surgical Treatment of Facial Fractures—Is There a Role? |
| title_full_unstemmed | Prophylactic Intraoperative Nasolacrimal Duct Intubation in Surgical Treatment of Facial Fractures—Is There a Role? |
| title_short | Prophylactic Intraoperative Nasolacrimal Duct Intubation in Surgical Treatment of Facial Fractures—Is There a Role? |
| title_sort | prophylactic intraoperative nasolacrimal duct intubation in surgical treatment of facial fractures is there a role |
| topic | nasolacrimal facial fractures orbit epiphora |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1744407 |
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