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Updated: Jul 19, 2026
Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction
Published on: October 13, 2017
Nasolacrimal System Fractures: A Description of Radiologic Findings and Associated Outcomes
Ravi K Garg1, Michael J Hartman, Mark J Lucarelli
1From the *Division of Plastic and Reconstructive Surgery, Department of Surgery, †Section of Neuroradiology, Department of Radiology, ‡Oculoplastic, Facial Cosmetic and Orbital Surgery, and §Department of Surgery, University of Wisconsin, Madison, WI.
Facial trauma patients with bony nasolacrimal system (NLS) fractures have a 10% risk of developing epiphora or dacryocystitis. Specific fracture patterns, like nasomaxillary buttress displacement, predict the need for lacrimal surgery.
Area of Science:
- Ophthalmology
- Plastic Surgery
- Trauma Surgery
Background:
- Fractures of the bony nasolacrimal system (NLS) are not well-described in facial trauma.
- Characterizing NLS injuries aids in predicting lacrimal outflow obstruction (epiphora, dacryocystitis) and the need for surgery.
Purpose of the Study:
- To characterize NLS fractures in craniofacial trauma patients.
- To correlate specific fracture patterns with clinical outcomes like epiphora, dacryocystitis, and need for lacrimal surgery.
Main Methods:
- Retrospective review of CT scans for craniofacial trauma patients (2001-2005).
- Inclusion criteria: NLS fracture and ≥1 year follow-up.
- Analysis of fracture patterns and clinical outcomes (epiphora, dacryocystitis, dacryocystorhinostomy) using Fisher exact test.
Main Results:
- 104 NLS fractures identified in 1980 craniofacial trauma patients.
- 10.6% developed epiphora or dacryocystitis; 1.9% required dacryocystorhinostomy (DCR).
- Avulsion of lacrimal crest, bone fragment in NLS, duct compression >50%, and nasomaxillary buttress displacement correlated with epiphora/dacryocystitis (P<0.05). Nasomaxillary buttress displacement predicted need for DCR (P=0.03).
Conclusions:
- Patients with NLS fractures have a ~10% risk of developing epiphora or dacryocystitis.
- Five NLS fracture findings significantly associated with lacrimal outflow obstruction identified.
- Nasomaxillary buttress fracture/displacement indicates higher risk for future lacrimal surgery.
