Outcomes of dacrocystorhinostomy in patients with head and neck tumors

Abstract

5584 Background: To evaluate the outcomes of dacryocystorhinostomy (DCR) in patients with head and neck tumors. Methods: The clinical records of all 31 patients with head and neck tumors who underwent DCR for nasolacrimal duct blockage at M.D. Anderson Cancer Center between 1999 and 2003 were retrospectively reviewed for outcome and complications of DCR. Results: Nasolacrimal duct blockage was diagnosed in 35 eyes of 31 patients. The tumor diagnoses were as follows: squamous cell carcinoma (SCCA), 18 patients (16 had paranasal-sinus SCCA and 2 had skin SCCA); chondrosarcoma, 3; sinonasal carcinoma, 2; adenoid cystic carcinoma, 2; sinonasal papilloma, 2; esthesioneuroblastoma, 1; hemangiopericytoma,1; ameloblastoma,1; and ostoesarcoma,1. Twenty-one patients had a maxillectomy and 7 patients had other sinus surgeries before DCR. Six patients had had silicone intubation at the time of maxillectomy but later developed epiphora and nasolacrimal duct blockage. Ten patients had radiotherapy and 14 had chemotherapy and radiotherapy before DCR. The mean time between completion of radiotherapy and DCR was 24 months (median, 31.5 months), and the mean time between completion of chemotherapy and DCR was 21.5 months (median, 12.5 months). All 31 patients (35 eyes) experienced improvement of epiphora after DCR, but in 4 patients (4 eyes), epiphora recurred during the study period. Probing and irrigation in these 4 patients revealed recurrent nasolacrimal duct blockage. In 1 of these 4 patients, tumor recurrence in the nasal cavity was the cause; he subsequently underwent a total rhinectomy. In another patient, recurrent blockage was due to extrusion of the Pyrex glass tube, which was later replaced. The other 2 patients with recurrent blockage elected not to have additional surgery. None of the patients who had had radiotherapy developed osteoradionecrosis. Two patients had mild wound infections, which resolved after 1 week of systemic antibiotic therapy. Conclusions: DCR alleviates nasolacrimal duct blockage in the majority of patients with head and neck tumors with this side effect. No significant financial relationships to disclose.