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

ABSTRACT

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.