lacrimal canalicular anastomosis

Traual tubule rupture is a common ocular traumatic disease, and lacrimal duct anastomosis is the main method of treatment. However, some patients could not find the nasal end of the lacrimal canal for various reasons and could not perform the anastomosis of the canaliculus. Treatment of diseases: ocular trauma Indication Tear tube lacrimal sac anastomosis is applicable to: 1. The middle or the end of the lacrimal canal is blocked. 2. Total tear tubule obstruction. Contraindications The lacrimal sac has acute inflammation. Preoperative preparation The nasal and sinus conditions were first examined, and antibiotic eye drops were taken 1 to 2 days before the operation. Surgical procedure Surgery is best performed under a surgical microscope. 1. 4 to 5 mm on the medial malleolus side, about 4 mm above the medial malleolar ligament, and make an arc-shaped longitudinal skin incision slightly to the temporal side, 10 to 12 mm long. 2. Use a small scissors to separate the incision downwards, expose the medial malleolus ligament, and then separate the thin fascia to expose the muscle layer. 3. Cut the medial malleolar ligament between the orbicularis tendon and the beginning of the palate, which is just above the anterior tear, so as not to damage the orbicularis muscle fibers attached to it. Place the dilator. 4. Along the front tears, the acral muscles of the eye are separated to separate the muscle fibers, thereby exposing the tears. Cut the tears along the front tears, so as not to damage the anterior muscle fibers of the orbicularis muscles attached to the tears. The tears are separated and the front wall of the lacrimal sac is completely exposed. 5. Insert the lacrimal probe into the punctum and explore the obstruction of the lacrimal canal. Hold the lancet tightly against the probe head and cut the lacrimal canal vertically to expose the probe tip. Be careful not to damage the tissue surrounding the lacrimal canal or clear the obstruction tear duct. 6. Cut the anterior wall of the lacrimal sac longitudinally. The incision is generally about 4 mm long. If the middle part of the lacrimal canal is obstructed, the location of the incision should be in the middle of the lacrimal sac; if it is obstructed at the end or the total lacrimal canal, the incision should be slightly nasal. Before the anastomosis, the lacrimal sac was cut from the tip of the longitudinal incision to the nasal side by 2 to 3 mm, so that the incision was "" shaped. 7. Non-penetrating anastomosis of the lacrimal canal and lacrimal sac. The method is to invert the "" shaped flap of the lacrimal sac, so that it is consistent with the lower end of the lacrimal canal, and the upper part of the lacrimal canal is matched with the opposite side of the lacrimal sac, which can be used with an 8-0 nylon thread. The upper and lower parts are intermittently non-penetratingly sutured with 2 needles. When the anastomosis is difficult to connect, the lacrimal sac can be released from the nasal margin of the lacrimal sac and then ligated. 8. Before ligation of the anastomosis, first wear a thin plastic tube in the lacrimal duct. The two ends of the tube are respectively inserted into the lacrimal canal from the upper and lower punctum, through the lacrimal sac, the nasolacrimal duct, and finally from the nasal vestibule. 9. Suture the tear septum, medial malleolus ligament and skin in turn. The skin should be sutured continuously with silk thread. Suture the conjunctival sac coated antibiotic eye ointment, add a small yarn pillow at the wound surface, and cover the eye pad after covering.