Congenital dacryocystoceles controlled by nCPAP via nasal mask in a neonate

Bilateral Congenital Nasolacrimal Duct Cyst: A Rare Cause of Nasal Obstruction

Nasal obstruction in neonates often results in respiratory discomfort, as neonates are obligate nasal breathers. Congenital bilateral nasal obstruction is an emergency situation which is generally secondary to choanal atresia. Rarely bilateral nasolacrimal duct (NLD) cyst causing intranasal swelling may be the underlying etiology. Neonatal respiratory distress warrants immediate measures to secure the airway and prompt investigations to reach a diagnosis for a definitive management. We describe a case of two-day-old girl with intermittent breathing difficulty because of bilateral NLD cysts causing nasal obstruction. The patient improved with conservative medical management.

Congenital midnasal stenosis: Conservative management

INTRODUCTION

Congenital midnasal stenosis (MNS) is an extremely rare disease which may be life threatening, and shows difficulty in diagnosis and management. This case series summarizes superiority of using intranasal mometasone furoate spray (IMS) and continuous positive airway pressure (CPAP) to treat nasal obstruction in neonates with MNS.

METHODS

This study reviewed six consecutive cases of MNS.

RESULTS

Three patients were treated with IMS and CPAP. Two patients were treated with endoscopic balloon dilatation without stenting, followed by IMS and CPAP due to persisting nasal obstruction after the operation. One patient was treated with endoscopic balloon dilatation without stenting alone.

CONCLUSION

This study is the first to review the use of CPAP and IMS as an effective therapy for some patients with MNS. It suggests that conservative management with CPAP and IMS may be an alternative therapeutic option to surgery.

Congenital Dacryocystocele: A Major Review

PURPOSE

To provide a systematic review of the literature on congenital dacryocystoceles (CDCs) and summarize their presentations, investigations, management, and outcomes.

METHODS

The authors performed a PubMed search of all articles published in English on CDCs. Data captured include demographics, clinical presentations, investigations, management modalities, complications, and outcomes. Fourteen major series (10 or more than 10 cases) and 89 isolated case reports/series on CDCs with a collective patient pool of 1,063 were studied in detail. Specific emphasis was laid on addressing the controversial issues including initial conservative versus surgical management and the role of endoscopic evaluation.

RESULTS

Numerous terminologies have been used to describe CDC. Congenital dacryocystoceles are rare variants of congenital nasolacrimal duct obstructions and comprise of 0.1% to 0.3% of all such cases. There is a female predilection (64.2%, 683/1,063) and the mean age at presentation is at 7 days of birth. Initial conservative treatment can be a viable option in the absence of an acute dacryocystitis or a respiratory distress. Endoscopy-assisted probing appears to have better outcomes as compared with the in-office probing. Congenital dacryocystoceles with acute dacryocystitis are preferably managed with intravenous antibiotics and an early probing under endoscopy guidance to avoid missing intranasal cysts. Marsupialization is the preferred technique in the management of intranasal cysts. Silicone intubation was rarely used and has no definitive indications. Dacryocystorhinostomy is very rarely needed in the management of CDC.

CONCLUSIONS

Congenital dacryocystocele is a commonly accepted term and its use should be advocated to enhance uniformity in reporting. Endoscopic evaluation of CDC is useful in the diagnosis and treatment of associated intranasal cysts and enhances the rates of successful outcomes.

A rare cause of intermittent respiratory distress and epiphora in the newborn: congenital dacryocystocele

Congenital dacryocystocele is a malformation of the nasolacrimal system. Most of the cases can be successfully treated with conservative treatment options such as sac massage. Congenital dacryocystoceles with concomitant intranasal cysts causing respiratory distress in the newborns are rarely published. In this case report we presented a 2-week-old newborn with bilateral congenital dacryocystoceles causing intermittent respiratory distress. We discuss the importance of nasal endoscopic treatment and multidisciplinary approach for these rare malformations in the light of the current literature.

Long-term outcomes of cruciate marsupialization of intra-nasal cysts in patients with congenital dacryocele

OBJECTIVES

To evaluate the long-term outcomes of cruciate marsupialization of intranasal cysts associated with congenital dacryocele.

METHODS

This is a retrospective review of 15 patients of dacryoceles with intranasal cysts who underwent cruciate marsupialization of the medial wall of the cyst. Post-operative follow up for a minimum of 9 months was an inclusion criterion for analysis. Data analyzed include demographics, clinical presentations, previous interventions, associated systemic abnormalities, clinical course following marsupialization and recurrences. Primary outcome measures were resolution of the dacryocele and symptomatic relief from epiphora.

RESULTS

The mean age at presentation was 1.6 months with a female preponderance (60%). History of prematurity (pre-term) was noted in 20% (3/15). Swelling in the lacrimal sac area (dacryocele) was the universal presentation. Five patients (33.3%) had a prior conservative treatment. Four patients (26.6%) had respiratory distress with feeding. Acute dacryocystitis was noted in 26.6% (4/15). At a mean follow up of 19.1 months, successful outcomes were achieved in 86.6%.

CONCLUSION

Cruciate marsupialization of intranasal cysts achieves good results in patients with congenital dacryocele, which are maintained over a long period of time. Early diagnosis and management may prevent acute dacryocystitis in these patients.