The evaluation of the effects of lateral osteotomies on the lacrimal drainage system after rhinoplasty using active transport dacryocystography

The lacrimal drainage system (LDS) is vulnerable to surgical trauma during rhinoplasty. We aimed to investigate the possible effects of the low lateral osteotomies on the LDS during rhinoplasty using active transport dacryocystography (ATD) at the late postoperative stage. Twenty patients who underwent open rhinoplasty were evaluated by ATD between the sixth and seventh postoperative months. Presence of the LDS dehiscence and the absence of the passage of the contrast material into the inferior meatus were noted as signs of injury to the LDS in ATD. The proximity of the osteotomy site to the LDS was measured using three different measurements in ATD. The distance from the lacrimal fossa to the lateral osteotomy site, the distance from the inferior meatus to the lateral osteotomy site and the distance from the middle point of the lacrimal fossa and inferior meatus to the lateral osteotomy site were measured. The anatomic integrity of the bone structure around the LDS was preserved in all patients and free drainage of contrast media from the fossa lacrimalis to inferior meatus was observed in ATD evaluation of all patients. The average distance from the LDS to the lateral osteotomy site was found to be between 7-8.8 mm. In conclusion, the low lateral osteotomy is a safe method in order to avoid trauma to the LDS, and ATD seems an appropriate diagnostic technique in evaluation of the LDS after rhinoplasty.