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Poster presented at The Triological Society Meeting Jan 24-26, 2013 in Scottsdale , Arizona.



The lacrimal sac is the structure most vulnerable to injury when performing osteotomies for rhinoplasty. When performed in a low lateral position or along the frontal process of the frontal-maxillary suture, osteotomies have the potential to tear the medial canthal ligament and injure the underlying lacrimal sac resulting in dacryocystitis. We report a case of dacryocystitis in a 19 year old male who presented with recurrent episodes of pain, tearing, and discharge from his left eye following primary rhinoplasty. He was found to have obstruction of the lacrimal system secondary to a low lateral osteotomy with an impinging bone fragment on imaging. Endoscopic dacryocystorhinostomy was performed using a Sonopet® ultrasonic bone aspirator under image guidance to remove the bone fragments posing risk to further injury to the lacrimal sac and orbit. Patency of the nasolacrimal duct was achieved and the patient remained symptom free at 6 month follow up. We describe the first case of recurrent dacryocystitis following rhinoplasty requiring treatment by an endoscopic dacryocystorhinostomy (DCR). Endoscopic DCR with the use of the ultrasonic bone aspirator provides several advantages over open DCR, including the lack of an external incision and decreased risk of injury to the adjacent orbital soft tissue anatomy including the lacrimal system.