Basic Procedure

The conjunctivorhinostomy is one of the most challenging techniques in lacrimal duct repair creating a lacrimal passage between the fornix of the conjunctiva and the nasal cavity. Requiring delicate and tedious dissection, the procedure should be performed under general anesthesia. After application of vasoconstrictors to the nasal mucosa and local infiltration of the lateral nasal wall using 1% xylocain with 1:100,000 epinephrine, the skin of the medial canthal area is incised in a curvilinear fashion from the level of the medial canthal ligament along to the orbital rim (Fig. 11.1a). This is followed by cauterization of the angular vessels and by incision and elevation of the periosteum of the lateral nasal wall, the medial orbital wall, and the frontal process of the maxilla. The ex

Fig. 11.1. Basic procedures in conjunctivorhinostomy. a Curvilinear skin incision from the area of the medial canthal ligament along the orbital rim. b External rhinostomy: removal of the exposed bone below the medial canthal ligament and along the orbital rim using a diamond drill

posed bone below the medial canthal ligament, along the orbital rim is removed in an area of about 1.5 cm in diameter using a diamond drill (Fig. 11b). Taking off the bone special attention has to be paid in the preservation of the underlying nasal mucosa. For better exposure of the nasal mucosa the middle turbinate should be fractured medially from an endonasal approach. Once the osteal perforation has been completed an incision of the infero-medial fornix of the conjunctiva is done in a line just below the caruncle along the orbital rim. This is followed by blunt dissection behind the orbital septum and underneath the lacrimal sac creating a tunnel to the osseous perforation.

For the creation of the mucosal lining of the new lacrimal passage there are three options.

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Essentials of Human Physiology

Essentials of Human Physiology

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