Nasal endoscopy in the treatment of congenital lacrimal sac mucoceles

• Published in: International journal of pediatric otorhinolaryngology Vol. 67; no. 3; pp. 255 - 261
• Main Authors: Levin, Alex V, Wygnanski-Jaffe, Tamara, Forte, Vito, Buckwalter, Jeffrey A, Buncic, J.R
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ireland Ltd 01.03.2003; Elsevier
• Subjects: Biological and medical sciences; Dacryocystitis - congenital; Dacryocystitis - pathology; Dacryocystitis - surgery; Dacryocystorhinostomy; Diseases of eyelid, conjunctiva and lacrimal tracts; Endoscopy; Female; Humans; Infant; Infant, Newborn; Infantile dacrocystitis; Intranasal cyst; Lacrimal Duct Obstruction - congenital; Lacrimal Duct Obstruction - pathology; Lacrimal sac mucocele; Male; Marsupialization; Medical sciences; Mucocele - congenital; Mucocele - pathology; Mucocele - surgery; Nasal Cavity - surgery; Nasal endoscopy; Ophthalmology; Outcome Assessment (Health Care); Prospective Studies; Reproducibility of Results; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the eye and orbit; Lacrimal sac mucocele; Marsupialization; Nasal endoscopy; Infantile dacrocystitis; Intranasal cyst; Human; Endoscopic surgery; Mucocele; Nose disease; Congenital; Lacrimal sac; Infant; Lacrimal apparatus disease; Eye disease; Concomitant disease; Treatment; Surgery; Nose; Cyst; ENT disease; Benign neoplasm
• ISSN: 0165-5876; 1872-8464
• DOI: 10.1016/S0165-5876(02)00379-8

Purpose: To determine the incidence of intranasal cysts associated with lacrimal sac mucoceles and the cure rate with nasal endoscopic cyst marsupialization. Design: Interventional case series. Methods: Setting: University-affiliated teaching hospital. Patient Population: Twenty-five infants with non infected or infected lacrimal sac mucoceles or dacrocystitis without obvious mucocele were consecutively enrolled. Intervention Procedures: Management included local lacrimal massage, parenteral antibiotics, and when still symptomatic, nasolacrimal duct probing with concomitant nasal endoscopy. Intranasal cysts identified were marsupialized until the distal end of the nasolacrimal duct probe was visualized. Main Outcome Measures: Presence of intranasal cyst identification and cure rate. Results: Infants were 4 days to 10 weeks old (mean 19 days). Forty-eight percent had a bluish cutaneous mass inferior and lateral to the lacrimal sac. Twenty percent were bilateral. At presentation, 76 percent had dacrocystitis. Fourteen percent had respiratory distress. Only one child responded to medical management. At endoscopy, 23 of 24 infants had ipsilateral intranasal cysts. The one child without nasal cyst had recurrent dacrocystitis and no mucocele. All children with mucocele were cured except one child with residual nasolacrimal duct obstruction. Conclusions: Lacrimal sac mucoceles were almost always associated with intranasal cysts. Nasal endoscopy is a valuable addition to the treatment plan for lacrimal sac mucoceles not responding to a brief trial of massage or infantile dacrocystitis. To avoid potential complications, we recommend against waiting until infection occurs before proceeding with surgery.