Lacrimal intubation in the primary repair of midfacial fractures.

Midfacial trauma causes a variety of functional and cosmetic problems that concern many surgical specialties. Fractures of the lacrimal sac fossa and lacrimal canal and compromise of the intrinsic membranous pathways are frequently not addressed, requiring late lacrimal bypass surgery in many cases. Silicone intubation of 11 disrupted distal pathways was performed as part of the primary, interdisciplinary repair of midfacial fractures. Revision of two systems was necessitated by later surgery performed for unrelated problems. In the remaining nine primarily intubated systems, patency was maintained in long-term follow-up. The role of the ophthalmic surgeon in the recognition and primary intubation of fractured distal lacrimal pathways should be stressed among colleagues in otolaryngology, plastic surgery, and maxillofacial surgery.