Nasolacrimal duct reconstruction with nasal mucoperiosteal flap

Surgical repair of lacrimal drainage apparatus may be quite difficult in patients with maxillofacial injuries involving extensive structural damage. When the primary tear tract has become nonamendable or inaccessible, it would then be necessary to set up an alternate draining route for tear passage. Conjunctivorhinostomy with a Jones tube is an effective diversionary treatment method, and yet this procedure might be plagued with problems related to alloplastic device usage. Autologous tissue is therefore best suited for nasolacrimal conduit restoration.A superiorly based mucoperiosteal flap, 11 to 13 mm in width and 20 to 25 mm in vertical length, is mobilized from lateral nasal wall and fashioned into a tubelike conduit. This construct is then turned superior-laterally and connected to the conjunctival sac. The fistula tract thus formed has a sufficiently large caliber and is lined entirely with normal mucosal epithelium. Such a feature may exert a favorable influence upon the long-term patency of the tear passage. This approach is applied successfully in 3 consecutive patients of lacrimal system obstruction, one of whom even had experienced 2 failed attempts of Jones tube insertion beforehand. The tactics and experiences in managing these 3 cases form the basis of this report.