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Lipogranuloma: a preventable complication of dacryocystorhinostomy
1Department of Ophthalmology, White Memorial Medical Center, Los Angeles, CA 90033, USA.
Abstract:
This report describes the unusual occurrence of lipogranuloma at the incision site of dacryocys-torhinostomy. Four patients had soft cystic masses after external dacryocystorhinostomy for acquired nasolacrimal duct obstruction. This was attributed to the antibiotic ointment vehicle that coated the petroleum jelly-impregnated gauze placed intranasally to prevent epistaxis. Postoperatively, all four patients had an encapsulated cystic mass within 3 weeks. Three of the masses were excised under local anesthesia and one was aspirated. None of the masses recurred.
Insights
Lipogranulomas, or cystic masses, can form at surgical incision sites after dacryocystorhinostomy. This unusual reaction is linked to antibiotic ointment used with gauze during the nasolacrimal duct obstruction surgery.
Area of Science:
- Ophthalmology
- Surgical Pathology
Background:
- Dacryocystorhinostomy is a surgical procedure to restore tear drainage.
- Acquired nasolacrimal duct obstruction can necessitate this surgery.
- External approaches are used for dacryocystorhinostomy.
Observation:
- Four patients developed soft, cystic masses post-external dacryocystorhinostomy.
- These masses appeared within 3 weeks of the surgical procedure.
- The masses were located at the incision site.
Findings:
- The cystic masses were identified as lipogranulomas.
- The condition was attributed to the vehicle of antibiotic ointment on gauze.
- Gauze was used intranasally to prevent epistaxis during surgery.
- Three masses were surgically excised, and one was aspirated.
- No recurrence of the masses was observed post-treatment.
Implications:
- Highlights a potential complication of dacryocystorhinostomy.
- Suggests a link between topical antibiotic ointment vehicles and granuloma formation.
- Incision site lipogranulomas are treatable with excision or aspiration.
- Informs surgical technique and postoperative care protocols for dacryocystorhinostomy.