Post oncological lacrimal duct reconstruction; a practical classification system for reconstructive planning and short-term results of a case series.

Publication date: Available online 3 August 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): M.V. van Burink, H.A. Rakhorst, G.M. van Couwelaar, U. Schmidbauer

Summary / Abstract

Background

: Surgical resection of skin tumors in the medial canthal area may damage the lacrimal duct and can result in chronic ephiphora. Post oncologic reconstruction of the lacrimal duct has not been studied extensively. The current study discusses the anatomical and functional features of the lacrimal duct. It describes short-term functional outcomes after monocanalicular reconstruction of the lacrimal duct in a case series of 10 patients.

Methods

: From February 2015 until October 2017 all patients with a post oncological lacrimal duct defect were analyzed to make an anatomical classification. The functional outcomes of patients, after monocanalicular reconstruction was measured with the Munk scale up to three months after stent removal.

Results

: Twelve patients had lacrimal duct defects after mohs resection. Anatomical characteristics were used to create a clinical classification for lacrimal duct defects. This classification divides the upper (U) and lower (L) proximal lacrimal duct in two sections which can be damaged. The punctum and pars verticalis (1), the canaliculus horizontalis (2) or combined (3). The Common lacrimal duct (C) is the distal part of the lacrimal duct and can also be affected. Ten patients where analyzed after lacrimal duct reconstruction. Three months after stent removal none of the patients suffered from ephiphora.

Conclusions

: This article proposes an anatomical classification for lacrimal duct defects in the proximal lacrimal drainage system. The classification can be applied in comparing cases and determining reconstructive strategies after oncologic skin tumor resection. Short-term results are promising for future efforts to reconstruct the lacrimal duct.