Lacrimal hyposecretion: a surgical complication of juvenile nasopharyngeal angiofibroma

Abstract

Purpose The aim of this study was to evaluate lacrimal hyposecretion in the surgical management of juvenile nasopharyngeal angiofibroma (JNA) and discuss how to prevent and treat this expected surgical complication. Materials and methods Six cases of JNA were extirpated surgically in the last 3 years in our department. The clinical signs, results of the total tear secretion test (Schirmer I test), imaging studies, surgical findings, and pathologic changes in these cases are reviewed retrospectively. Results Three of the 6 cases developed an irritated dry eye on the affected side postoperatively as a result of lacrimal hyposecretion, caused by damage to or partial removal of the pterygopalatine ganglion and vidian nerve. On follow-up for 1 to at least 2 years, the clinical signs disappeared in 2 cases, whereas there was no improvement in 1 case. Conclusions If a JNA originates near the pterygopalatine foramen adjacent to the pterygopalatine ganglion and vidian nerve, these may be damaged or partially removed intraoperatively. The consequent lacrimal hyposecretion can be a temporary or permanent complication. Significance A few reports have described lacrimal hyposecretion as a surgical complication of JNA; there have been no articles reporting the prognosis of this complication or the related pathologic findings of the involved pterygopalatine ganglions. Prevention of this complication remains a clinical challenge.