Postoncological lacrimal duct reconstruction: A practical classification system for reconstructive planning and short-term results of a case series

J Plast Reconstr Aesthet Surg. 2018 Dec;71(12):1796-1803. doi: 10.1016/j.bjps.2018.07.024. Epub 2018 Aug 3.

Abstract

Background: Surgical resection of skin tumors in the medial canthal area may damage the lacrimal duct and can result in chronic epiphora. Postoncologic 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 to October 2017, all patients with a postoncological lacrimal duct defect were analyzed to make an anatomical classification. The functional outcomes of patients after monocanalicular reconstruction were measured with the Munk scale up to 3 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 into 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 were analyzed after lacrimal duct reconstruction. Three months after stent removal, none of the patients suffered from epiphora.

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.

Keywords: Ductus lacrimalis; Eyelid reconstruction; Lacrimal duct reconstruction; Periorbital reconstruction; Periorbital tumor; Tear duct.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Carcinoma, Basal Cell / surgery
  • Eyelid Neoplasms / surgery
  • Eyelids / surgery
  • Female
  • Humans
  • Lacrimal Apparatus / surgery*
  • Lacrimal Apparatus Diseases / classification
  • Lacrimal Apparatus Diseases / etiology
  • Lacrimal Apparatus Diseases / surgery*
  • Male
  • Middle Aged
  • Mohs Surgery / adverse effects
  • Plastic Surgery Procedures / methods*
  • Skin Neoplasms / surgery