CPT® Code 68745

1. Indications

Conjunctivorhinostomy is indicated for patients experiencing epiphora due to obstruction of the upper lacrimal structures. The following conditions may warrant this surgical intervention:

• Epiphora Excessive tearing resulting from blockages in the lacrimal drainage system, particularly affecting the punctum and canaliculi.
• Lacrimal duct obstruction Blockage in the nasolacrimal duct that prevents normal tear drainage.
• Chronic dacryocystitis Inflammation of the lacrimal sac, often due to infection or obstruction, leading to persistent tearing and discomfort.

2. Procedure

The conjunctivorhinostomy procedure involves several key steps to ensure successful creation of a passageway for tear drainage. The following outlines the procedural steps:

• Step 1: Anesthesia The procedure typically begins with the administration of local anesthesia to ensure patient comfort during the surgery. In some cases, general anesthesia may be used depending on the patient's needs and the complexity of the case.
• Step 2: Incision A careful incision is made in the lower lid conjunctival sac. This incision allows access to the underlying structures and is crucial for the subsequent steps of the procedure.
• Step 3: Mucosal Flap Creation The surgeon raises mucosal flaps from the conjunctival sac, which will later be used to create the connection to the nasal cavity.
• Step 4: Bone Perforation The frontal process of the maxillary bone is then perforated. This step is essential as it opens a passageway between the conjunctival sac and the nasal fossa, facilitating the drainage of tears.
• Step 5: Passageway Formation The surgeon ensures that the newly created passageway is adequately formed to allow for the free flow of tears from the conjunctival sac into the nasal cavity.
• Step 6: Closure Finally, the mucosal flaps are sutured in place to secure the new connection, ensuring that the passageway remains open for effective tear drainage.

3. Post-Procedure

After the conjunctivorhinostomy procedure, patients may experience some swelling and discomfort in the surgical area. Post-operative care typically includes the use of prescribed analgesics to manage pain and anti-inflammatory medications to reduce swelling. Patients are advised to avoid strenuous activities and to follow up with their healthcare provider for monitoring the healing process. It is also important to maintain proper hygiene around the surgical site to prevent infection. The expected recovery time may vary, but most patients can anticipate a gradual improvement in symptoms as the surgical site heals and the new drainage pathway becomes functional.