Contributing Factors to Prevent Prolonged Epiphora After Maxillectomy

Objective: To analyze the incidence of prolonged epiphora after maxillectomy according to transected nasolacrimal duct management technique, type Of tumor, radiotherapy, and timing of tube removal and performance of dacryocystorhinotomy. Design: Retrospective medical record review. Settings: University hospitals. Patients: We studied 89 patients (90 cases) who underwent nasolacrimal duct transection during maxillectomy with preservation of orbital contents for the management of sinonasal tumors between July 1, 1996, and January 31, 2008. Main Outcome Measures: The incidence of prolonged epiphora was analyzed according to 4 different transected nasolacrimal duct management techniques: simple transection without any additional procedure, silicone tube stenting, transcanalicular Silastic stenting, and marsupialization Without stenting. We also analyzed the relationship between other factors (type of tumor, radiotherapy, and timing of tube removal) and the incidence of prolonged epiphora. Prolonged epiphora was defined as persistent if it lasted longer than 6 months. Results: The overall incidence of prolonged epiphora was 15.6% (14 of 90 cases). The prolonged epiphora rates differed according to the management technique (no procedure, 27.3% [3 of 11 cases]; silicone tube, 7.0% [4 of 57 cases]; transcanalicular Silastic stenting, 66.7% [4 of 6 cases]; marsupialization, 18.8% [3 of 16 cases]; P=.002). The silicone tube technique showed the lowest rate (odds ratio=0.20, P=.06). In contrast, the incidence of prolonged epiphora was not affected by the type of tumor, postoperative radiotherapy, or timing of tube removal. Conclusion: Silicone tube stenting can be used as the effective and convenient transected nasolacrimal duct re-constructive technique to prevent prolonged epiphora.