Bilateral Dacryocystoceles Resection

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Author: Yi-Chun Carol Liu
Published:
Specialties: Ophthalmology, Otolaryngology
Schools: Baylor College of Medicine, Texas Children's Hospital
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Basic Info

Contributor: Tyler McElwee

Congenital dacryocystocele describe the distended lacrimal sac in neonates with or without associated intranasal cyst.  The prevalence is about 0.1% of infants with congenital nasolacrimal duct obstruction and a slight prevalence in female infants.  It refers to cystic distention of the lacrimal sac as a consequence of the nasolacrimal drainage system obstruction.  It typically presents as a bluish swelling inferomedial to the medial canthus in the neonates.  Unilateral congenital dacryocystocele is more common but 12-25% of patients affected have bilateral lesions.  Ultrasound, CT scan or MRI can be used for diagnosis.  About half of the patient with acute dacryocystitis can be management with conservative management such as digital massage of lacrimal sac or in-office lacrimal duct probing.  The other half of patients will require surgery under general anesthesia for removal of the dacryocystocele.   Endoscopic excision of the intranasal cysts has been used successfully as a treatment option with Crawford stent placement.  Post-operatively patients are treated empirically with antibiotics and nasal saline.  No second look is usually planned unless patients develop significant nasal obstrctuion.

Editor Recruited By: Sanjay Parikh, MD, FACS

DOI: http://dx.doi.org/10.17797/16rnuq8n0y

Advanced

Procedure

Bilateral dacryocystoceles endoscopic resection

Indications

Bilateral dacryocystitis

Contraindications

Any contraindications to general anesthesia

Instrumentation

Setup

Preoperative Workup

Ultrasound, CT or MRI of sinus

Anatomy and Landmarks

Bilateral dacryocystoceles are located beneath inferior turbinate.

Advantages/Disadvantages

Advantages: Improved nasal airway and breathing when conservative management failed
Disadvantages: Risk of general anesthesia

Complications/Risks

Synechiae and nasal stenosis if there is demucosalization of the undersurface of the inferior turbinate and lateral nasal wall.

Disclosure of Conflicts

Synechiae and nasal stenosis if there is demucosalization of the undersurface of the inferior turbinate and lateral nasal wall.

Acknowledgements

References

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