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[Interdisciplinary endoscopic outpatient management of connatal dacryocystoceles]
W Hosemann1, B Lorenz, T Kühnel
1Klinik für Hals-Nasen-Ohren-Heilkunde der Universität Regensburg, Germany. hosemann@uni-greifswald.de
Insights
Congenital dacryocystoceles in newborns often resist conservative treatment. Endoscopic marsupialization offers an effective outpatient solution for this lacrimal duct obstruction.
Area of Science:
- Ophthalmology
- Pediatrics
- Rhinology
Context:
- Congenital dacryocystocele is a rare condition resulting from lacrimal duct stenosis.
- Conservative treatments like massage and antibiotics are often ineffective.
- Surgical intervention is typically recommended for persistent cases or secondary inflammation.
Purpose:
- To evaluate the efficacy of outpatient endoscopic marsupialization for congenital dacryocystoceles.
- To highlight the benefits of an interdisciplinary ophthalmological and rhinological approach.
Summary:
- This study reports on 15 neonates with 18 congenital dacryocystoceles, noting a female predominance.
- Conservative management failed in all cases.
- Endoscopic marsupialization under local anesthesia was successful in 14 cases.
- Two cases required general anesthesia due to anatomical obstruction.
- Three additional dacryocystoceles were managed with concomitant endonasal microsurgery during other procedures.
Impact:
- Endoscopic marsupialization provides a minimally invasive and effective treatment for congenital dacryocystoceles.
- Advocates for interdisciplinary outpatient evaluation and management of suspected cases.
- Suggests prompt diagnosis and treatment can lead to persistent symptom relief.
Abstract:
Dacryocystocele may represent a rare type of connatal stenosis of the lacrimal duct. If conservative measures fail and in case of secondary inflammation, probing or regular surgery is usually recommended. We report on 15 neonates suffering from 18 connatal dacryocystoceles which were presented to the clinic of ophthalmology at the 16th (6 - 44) day of life. There was a definite female preponderance (65 %). Conservative treatment (external massage, at times i. v. antibiotic therapy) had proven to be ineffective. The neonates were subjected to outpatient nasal endoscopy and the ballooning cyst of the inferior nasal meatus was managed by endoscopic marsupialization in 14 cases applying local anesthesia. Two nasal cysts had to be operated on in general anesthesia due to obstructing local anatomy which obviated endoscopical microsurgery. Three additional dacryocystoceles have been detected incidentally in 2 neonates being subjected to surgery in general anesthesia for choanal atresia and lacrimal probing respectively. The corresponding dacryocystoceles were managed by concomitant endonasal microsurgery. We advocate interdisciplinary (ophthalmological and rhinological) outpatient examination in all neonates with suspected dacryocystoceles. Diagnosis is based on palpation, probing and nasal endoscopy applying local anesthesia together with mucosal decongestion. Microsurgical marsupialization immediately follows and will lead to persisting relief of symptoms.