Management of Nasolacrimal-Cutaneous Fistula – A Maxillofacial Review and Sharing Experience.

Nasolacrimal cutaneous fistula can be presented with a complaint of discharge from an opening found below the eye and beside the nose. The patient’s history can be remarkable with repair of severe maxillofacial injuries. Examination reveals a nasolacrimal-cutaneous fistula extending from lacrimal sac to the overlying skin with co-existing nasolacrimal duct obstruction. To correct a lacrimal-cutaneous fistula, an endoscopic dacryocystorhinostomy should be performed to create a new opening to the lacrimal apparatus medially. Simultaneous irrigation and probing of the common canaliculus and fistula tract under direct visualization allows identification of the origin of the lacrimal fistula in relation to the internal ostium on the lateral lacrimal sac wall. Post-traumatic nasolacrimal disturbances are not uncommon findings in trauma patients and management of these chronic fistulas may be helpful for complete rehabilitation of the patient.

Preprosthetic Surgery: Review of Literature.

Following the loss of natural teeth after extraction, the bone begins to resorb. Th e results of this resorption are accelerated by wearing dentures and tend to aff ect the mandible more severely than the maxilla. Besides, general factors include the presence of nutritional abnormalities and systemic bone disease such as osteoporosis; endocrine dysfunction may aff ect bone metabolism. Preprosthetic surgical treatment must begin with a thorough history and physical examination of the patient. Sometimes, there are contraindications to surgery because the patient suff ers from serious general disease. Specifi c attention should also be given to laboratory tests which could inform us as to a degree of bone resorption. Successful treatment with removable prosthesis is dependent on many factors. One component that can profoundly aff ect treatment success is the condition of the denture-bearing tissues. Every eff ort should be made to ensure that both the hard and soft tissues are developed in a form that will enhance the patient’s ability to wear a denture. It is the responsibility of the practitioner to carefully evaluate and identify the need for any alteration of the denture-bearing areas and to educate the patient as to the importance of accomplishing this vital procedure.