Bloody tears after miniplate osteosynthesis for Le Fort I osteotomy

Abstract

Le Fort I osteotomy is usually carried out safely as an elective procedure in hospitals. However, minor complications can occur and are related to complex anatomy of the region where nerves, blood vessels and bony canals are present. One of the anatomical structures that can be damaged is the nasolacrimal duct. The patient underwent a Le Fort I osteotomy. After the surgery, blood was observed in her tears of the left eye. A lacrimal duct endoscopy was performed and computed tomography was requested and revealed an accidental perforation of the nasolacrimal duct by a screw of the miniplate osteosynthesis system. The screw (diameter: 2.0mm; length: 7.0mm) was then immediately removed under local anesthesia. The bleeding stopped at the first postoperative day and left no sequelae. Surgeons should be aware of the potential risk for an accidental penetration of the nasolacrimal duct during drilling and installation of the osteosynthesis screws for the rigid internal fixation of Le Fort I osteotomies. When faced with a complaint of bloody tears, the clinician should take a thorough history, then perform a careful eye examination and, when indicated, an otolaryngologic examination. Imaging of the sinuses may be useful when trauma is suspected.