Korean J Ophthalmol.  2006 Mar;20(1):65-69. 10.3341/kjo.2006.20.1.65.

A Silastic Sheet found during Endoscopic Transnasal Dacryocystorhinostomy for Acute Dacryocystitis

• Choi JS
• Lee JH
• Paik HJ

• KMID: 1099075
• DOI: http://doi.org/10.3341/kjo.2006.20.1.65

Abstract

PURPOSE: To report the case of a silastic sheet that was found during an endoscopic transnasal dacryocystorhinostomy for treatment of acute dacryocystitis with necrosis of the lacrimal sac. METHODS: A thirty-two year old male presented with painful swelling on the nasal side of his left lower lid two weeks prior to visiting this clinic. Fourteen years ago, the patient was involved in a traffic accident and underwent surgery to reconstruct the ethmoidal sinus. Lacrimal sac massage showed a regurgitation of a purulent discharge from the left lower punctum. Therefore, the patient was diagnosed with acute dacryocystitis and an endoscopic transnasal dacryocystostomy was performed the next day. RESULTS: The surgical finding showed severe necrosis around the lacrimal sac and a 20 x 15-mm sized silastic sheet was found crumpled within the purulent discharge. The sheet was removed, the lacrimal sac was irrigated with an antibiotic solution, and a silicone tube was intubated into the lacrimal pathway. After surgery, the painful swelling on the nasal side of left lower lid resolved gradually, and there were no symptomatic complications three months later. CONCLUSIONS: We report the first case where a silastic sheet applied during a facial reconstruction had migrated adjacent to the lacrimal sac resulting in severe inflammation.

Keyword

Dacryocystitis; Dacryocystorhinostomy; Silastic sheet

MeSH Terms

Silicones/*adverse effects
Reoperation
Prosthesis Implantation
Prosthesis Failure
Male
Intraoperative Period
Humans
Foreign-Body Migration/*complications/surgery
Facial Injuries/surgery
Ethmoid Sinus/injuries/surgery
*Endoscopy
Dimethylpolysiloxanes/*adverse effects
Dacryocystorhinostomy/*methods
Dacryocystitis/*etiology/surgery
Adult

Figure

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  Fig. 1 First visits. (A & B) External photograph showing remarkable redness and swelling of the left medial epicanthal area.

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  Fig. 2 Silastic sheet. (A) Intraoperative endoscopic photograph showing the tip of the silastic sheet adjacent to the lacrimal sac. (B) Intraoperative endoscopic photograph showing the removal of the silastic sheet with Blakesley forceps. (C) Photograph showing the silastic sheet, 20×15 mm in size, found during the endoscopic transnasal DCR.

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  Fig. 3 Three months after surgery. (A & B) External photograph showing reduced redness and swelling of the left medial epicanthal area.

Reference

1. Kikkawa DO, Heinz GW, Martin RT, et al. Orbital cellulitis and abscess secondary to dacryocystitis. Arch Ophthalmol. 2002. 120:1096–1099.

2. Campolattaro BN, Lueder GT, Tychsen L. Spectrum of pediatric dacryocystitis: medical and surgical management of 54 cases. J Pediatr Ophthalmol Strabismus. 1997. 34:143–153.

3. Sun X, Liang Q, Luo S, et al. Microbiological analysis of chronic dacryocystitis. Ophthalmic Physiol Opt. 2005. 25:261–263.

4. Briscoe D, Rubowitz A, Assia E. Changing bacterial isolates and antibiotic sensitivities of purulent dacryocystitis. Orbit. 2005. 24:29–32.

5. Coden DJ, Hornblass A, Haas BD. Clinical bacteriology of dacryocystitis in adults. Ophthal Plast Reconstr Surg. 1993. 2:125–131.

6. Haug RH, Nuveen E, Bredbenner T. An evaluation of the support provided by common internal orbital reconstruction materials. J Oral Maxillofac Surg. 1999. 57:564–570.

7. Gregory GF. Silicone-associated tissue reaction: a dilemma for oral and maxillofacial surgeons. Br J Oral Maxillofac Surg. 1995. 33:180–184.

8. Morrison AD, Sanderson RC, Moos KF. The use of silastic as an orbital wall defects: review of 311 cases treated over 20 years. J Oral Maxillofac Surg. 1995. 53:412–417.

9. Marone P, Perversi L, Monzillo V, et al. Ocular infections: antibiotics and bacterial adhesion on biomaterials used in ocular surgery. Ophthalmologica. 1995. 209:315–318.

10. Hwang K, Kita Y. Alloplastic template fixation of blow-out fracture. J Craniofac Surg. 2002. 13:510–512.

11. Choi YJ, Choi WC, Yang SW, Choi YK. A case of orbital abscess secondary to dacryocystitis. J Korean Ophthalmol Soc. 2005. 46:156–163.

12. Kim BJ, Yoo YS, Chang HK. The result of the dacryocystorhinostomy on the chronic dacryocystitis. J Korean Ophthalmol Soc. 1991. 32:715–719.

13. Kim JD. A study of dacryocystitis in neonates and infants. J Korean Ophthalmol Soc. 1984. 25:447–452.

14. Kim HB, Kwon OW, Kim YW, Hwang SK. Acute dacryocystitis due to pseudomonas aeruginosa. J Korean Ophthalmol Soc. 1983. 24:405–407.

15. Sung CK, Ha MC. A case of pseudomonas dacryocystitis. J Korean Ophthalmol Soc. 1982. 23:681–683.

16. Felt DP, Frueh BR. Exogenous ball valve in the lacrimal sac. Ophthal Plast Reconstr Surg. 1985. 1:115–117.

17. Cahill KV, Burns JA. Management of acute dacryocystitis in adults. Ophthal Plast Reconstr Surg. 1993. 9:38–41.

18. Hurwitz JJ, Rodgers KJA. Managements of acquired dacryocystitis. Can J Ophthalmol. 1983. 18:213–216.

19. Schliephake H, Schmelzeisen R, Maschek H, Haese M. Long-term results of the use of silicone sheets after diskectomy in the temporomandibular joint: clinical, radiographic and histopathologic findings. Int J Oral Maxillofac Surg. 1999. 28:323–329.

20. Giancarlo H, Mattucci KF. Silastic sheet keel in laryngeal reconstruction. Laryngoscope. 1985. 95:1123.

21. Stefansson GM, Stilwell JH. Use of silastic sheet in Apert's syndactyly. J Hand Surg Br. 1994. 19:248–249.

22. Kawase T, Gotoh K, Toya S. A wrapping clip combined with silastic sheet for emergent hemostasis: technical note. Neurosurgery. 1994. 35:769–770.

23. Michalevicz D, Chaimoff C. Use of a silastic sheet for widening the abdominal cavity in the surgical treatment of diaphragmatic hernia. J Pediatr Surg. 1989. 24:265–266.

24. Schmidt BL, Lee C, Young DM, O'Brien J. Intraorbital squamous epithelial cyst: an unusual complication of silastic implantation. J Craniofac Surg. 1988. 9:452–455.

25. Groombridge C, McGuinness J. Interesting case: Foreign body in the nose: an orbital silastic sheet had migrated into the nasal cavity. Br J Oral Maxillofac Surg. 2005. 43:56.

26. Lund VJ. kerr Ag, editor. Anatomy of the nose and paranasal sinuses. Scott-Brown's Otolaryngology. 1997. 6th ed. London: Butterworth & Heinemann;chap. 1.

27. Gullane PJ, Gilbert RW. Approach to naso-frontal-ethmoidal complex fracture. J Otolaryngol. 1985. 14:132–135.