Microdebrider assisted endoscopic marsupialization of congenital intranasal nasolacrimal duct cysts
To provide information on the clinical characteristics and management of an uncommon congenital nasolacrimal system anomaly, intranasal nasolacrimal duct cyst.
Three patients treated with microdebrider assisted endoscopic marsupialization for intranasal nasolacrimal duct cysts were included in this study. Management and outcomes are compared to previous reports in the literature.
Patients were presented in between 2007 and 2010. Diagnosis was made by clinical observation and endoscopic nasal examination. The first patient is a 1 year old child with congenital dacryocystocele presented as a right medial canthal mass and ipsilateral intranasal cyst. The second patient is a 60 days old child presented with nasal obstruction and feeding difficulty who was found to have bilateral intranasal cystic masses. The third patient was a 6 days old newborn with respiratory distress, whose nasal endoscopy revealed bilateral choanal atresia and left side intranasal cyst. All three cases were treated with nasal endoscopic marsupialization and no recurrence of symptoms and physical findings were found.
Intranasal nasolacrimal duct cysts may lead to nasal obstruction, respiratory distress and feeding difficulty. An otorhinolaryngologist should be consulted, as nasal endoscopy is fundamental for diagnosis. Microdebrider assisted endoscopic marsupialization is a safe and curative treatment.
Available from: Anne-Lise Poirrier
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ABSTRACT: Epiphora is a frequent reason for ophthalmologic consultation. Among the multiple causes, obstructions of the lacrimal excretory system are common. Sacal and postsacal obstructions are much more frequent than presacal obstructions. Obstruction at the level of the Hasner`s valve is rare and likely underestimated. The authors report the clinical history and the imaging of 3 patients with a cystic dilation of the distal end of the nasolacrimal duct (NLD). These patients were easily managed by an ENT surgeon. In one case, the surgery consisted of an endonasal DCR where in the 2 other cases, a marsupialisation of the cystic expansion of the nasolacrimal duct was successfully performed with the micro- debrider. The authors review the world literature on this specific topic. They conclude that a coronal sinus CT scan and an inferior meatus endoscopy should be included in the ophthalmologic work-up performed in all cases of low obstruction of the lacrimal system. When there is a dilation of the distal end of the NLD the marsupialisation of the cystic expansion in the inferior meatus is the option of treatment instead of performing a DCR. ENTs must play a role in the assessment and treatment of low obstructions of the lacrimal excretory system.
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ABSTRACT: Congenital nasolacrimal duct cyst (CNLDC) is a rare neonatal condition that can be life threatening when it occurs bilaterally. Herein we report a neonate with bilateral CNLDC that caused respiratory distress and was treated successfully with surgery. Post surgery, the patient was discharged from hospital without any complications. The case details, differential diagnosis, and management of CNLDC are discussed, along with a review of the relevant literature.
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