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Shivnani D, Kobal S, Kobal M, Sasikumar G, Raman EV. Neonatal Nasal Obstruction: A Comprehensive Analysis of Our 20 Years' Experience. Indian J Otolaryngol Head Neck Surg 2024; 76:2490-2501. [PMID: 38883526 PMCID: PMC11169106 DOI: 10.1007/s12070-024-04537-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/23/2024] [Indexed: 06/18/2024] Open
Abstract
Neonates are obligatory nasal breathers hence nasal obstruction is a very important symptom to be evaluated. Although causes can be trivial most of the time, they can be life-threatening in some. Respiratory distress immediately after birth, feeding difficulties, paradoxical cyanosis, and failure to thrive are the most evident symptoms, and determination of unilateral or bilateral involvement guides the rationale for elective or emergency intervention. This study aimed to evaluate the causes, presentation, and management of neonates with nasal obstruction. We collected the data of all the neonates evaluated for nasal obstruction at our hospital over the past 20 years from June 2003 to May 2023 and assessed the strategy of approach for diagnosis and management of those cases. In our study, the commonest cause for neonatal nasal obstruction was found to be choanal atresia and the rarest was iatrogenic. A variety of other causes were also reported. As neonatal nasal obstruction has a multitude of rare causes each carries a unique assessment and treatment plan. History taking and clinical examination are the most important parts of evaluation including endoscopic evaluation in an office-based setup. Imaging studies add to the evaluation of cases of anatomical obstructions and associated anomalies (syndromes). Early diagnosis and swift intervention can be life-saving. The need for follow-up visits and second-stage corrections should be emphasized in getting the best long-term results.
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Affiliation(s)
- Deepa Shivnani
- Department of Otorhinolaryngology and Head & Neck Surgery, Children's Airway& Swallowing Center, Manipal Hospital, Bangalore, Karnataka India
| | - Shruthi Kobal
- Department of Otorhinolaryngology and Head & Neck Surgery, Mahadevappa Rampure Medical College, Kalaburagi, Karnataka India
| | - Mallikarjun Kobal
- Department of Paediatrics, Mahadevappa Rampure Medical College, Kalaburagi, Karnataka India
| | | | - E V Raman
- Department of Otorhinolaryngology and Head & Neck Surgery, Children's Airway& Swallowing Center, Manipal Hospital, Bangalore, Karnataka India
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2
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Sunshein CK, Nestander CM, Eighmy MS. Respiratory Distress in a Newborn: Who Nose? Pediatr Rev 2023; 44:S85-S87. [PMID: 37777230 DOI: 10.1542/pir.2021-005313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Affiliation(s)
- Cpt Kyle Sunshein
- Department of Pediatrics, Brooke Army Medical Center, Fort Sam Houston, TX
| | - Cpt Matthew Nestander
- Department of Pediatrics, Neonatal Division, Brooke Army Medical Center, Fort Sam Houston, TX
| | - Maj Stephanie Eighmy
- Department of Pediatrics, Neonatal Division, Brooke Army Medical Center, Fort Sam Houston, TX
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3
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Lotfi C, Ksouri S. [Congenital dacryocystocele complicated by respiratory distress in a newborn: A case report]. J Fr Ophtalmol 2023; 46:e157-e159. [PMID: 37085373 DOI: 10.1016/j.jfo.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/06/2022] [Accepted: 06/11/2022] [Indexed: 04/23/2023]
Affiliation(s)
- C Lotfi
- Service d'ophtalmologie, hôpital régional de Kasserine, 1200 Kasserine, Tunisie; Faculté de médecine de Sousse, Sousse, Tunisie.
| | - S Ksouri
- Service d'ophtalmologie, hôpital régional de Kasserine, 1200 Kasserine, Tunisie; Faculté de médecine de Sousse, Sousse, Tunisie
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4
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Heichel J, Heindl LM, Struck HG. [Congenital anomalies in lacrimal drainage]. Laryngorhinootologie 2023; 102:423-433. [PMID: 37267966 DOI: 10.1055/a-1985-1656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Congenital dacryostenosis is the most common reason for ophthalmic consultation in childhood. It is most often caused by persisting of Hasner's membrane. However, congenital malformations of the lacrimal drainage system can also occur in rare cases. In the area of the proximal lacrimal drainage system, supernumerary lacrimal puncta and canaliculi can arise as well as diverticula, fistula, and atresia. The distal lacrimal drainage system can be affected by fistulas, amniotoceles, and cysts. Association of lacrimal malformations with congenital systemic diseases is reported in about 10% of cases. Depending on the severity of the symptoms, surgical rehabilitation can be performed, and endoscopic procedures and modern lacrimal drainage intubation systems may be employed.
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Affiliation(s)
- Jens Heichel
- Klinik für Augenheilkunde, Universitätsklinik Halle, Halle, Germany
| | - Ludwig M Heindl
- Department of Ophthalmology, University of Cologne, Köln, Germany
| | - Hans-Gert Struck
- Universitätsklinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Halle / Saale, Germany
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Han LP, Wang FX, Zhang CY. Special congenital dacryocystocele. Pak J Med Sci 2023; 39:608-610. [PMID: 36950401 PMCID: PMC10025701 DOI: 10.12669/pjms.39.2.6819] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/14/2022] [Accepted: 11/30/2022] [Indexed: 01/26/2023] Open
Abstract
Congenital Dacryocystocele is a rare disease of the eye and nose, which originates from congenital obstruction of lacrimal duct system, but accounts for a low proportion in congenital obstruction of lacrimal duct system. We present a case of congenital dacryocystocele to analyze the clinical features and to explore the clinical treatment effect of special congenital dacryocyst protrusion.
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Affiliation(s)
- Li-po Han
- Li-po Han, Department of Ophthalmology, Baoding Chilren’s Hospital, Hebei Baoding 071000, China
| | - Feng-xian Wang
- Feng-xian Wang, Department of Ophthalmology, Baoding Chilren’s Hospital, Hebei Baoding 071000, China
| | - Cheng-yue Zhang
- Cheng-yue Zhang, Department of Ophthalmology, Beijing Chilren’s Hospital, Beijing 010000, China
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Pierre PDTP, Pierre LL. Bilateral congenital dacryocystocele complicated with acute dacryocystitis. REVISTA BRASILEIRA DE OFTALMOLOGIA 2023. [DOI: 10.37039/1982.8551.20230005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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7
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Microdebridement of Intranasal Cysts Associated With Congenital Dacryocystoceles. Ophthalmic Plast Reconstr Surg 2022; 38:401-403. [DOI: 10.1097/iop.0000000000002140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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8
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Heichel J, Heindl LM, Struck HG. Congenital Anomalies in Lacrimal Drainage. Klin Monbl Augenheilkd 2022; 239:46-56. [PMID: 35120377 DOI: 10.1055/a-1717-2110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Congenital dacryostenosis is the most common reason for ophthalmic consultation in childhood. It is most often caused by persisting of Hasner's membrane. However, congenital malformations of the lacrimal drainage system can also occur in rare cases. In the area of the proximal lacrimal drainage system, supernumerary lacrimal puncta and canaliculi can arise as well as diverticula, fistula, and atresia. The distal lacrimal drainage system can be affected by fistulas, amniotoceles, and cysts. Association of lacrimal malformations with congenital systemic diseases is reported in about 10% of cases. Depending on the severity of the symptoms, surgical rehabilitation can be performed, and endoscopic procedures and modern lacrimal drainage intubation systems may be employed.
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Affiliation(s)
- Jens Heichel
- Klinik für Augenheilkunde, Universitätsklinik Halle, Deutschland
| | - Ludwig M Heindl
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Hans-Gert Struck
- Klinik für Augenheilkunde, Universitätsklinik Halle, Deutschland
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Bothra N, Ali MJ. Orbital involvement in lacrimal drainage disorders. Saudi J Ophthalmol 2021; 35:204-208. [PMID: 35601860 PMCID: PMC9116099 DOI: 10.4103/sjopt.sjopt_121_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/18/2021] [Accepted: 06/20/2021] [Indexed: 11/04/2022] Open
Abstract
Lacrimal sac is situated anterior to the orbital septum, which acts as a barrier, thus limiting the posterior migration of the pathologies affecting the lacrimal drainage system. Certain pathologies can breach this barrier and secondarily involve the orbit causing significant clinical manifestations. This posterior migration of pathology also has a significant influence on the management and outcomes. The present paper will discuss the lacrimal pathologies which secondarily involve the orbit and its influence on the management and outcomes.
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Affiliation(s)
- Nandini Bothra
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Mohammad J. Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, Telangana, India,Address for correspondence: Dr. Mohammad J. Ali, L.V. Prasad Eye Institute, Road No. 2, Banjara Hills, Hyderabad - 34, Telangana, India. E-mail:
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Schellini SA, Marques-Fernandez V, Meneghim RLFS, Galindo-Ferreiro A. Current management strategies of congenital nasolacrimal duct obstructions. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1945923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Silvana Artioli Schellini
- Department of Ophthalmology, Medical School, State University of Sao Paulo, Botucatu, São Paulo, Brazil
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Alvo A, Villarroel G, Sedano C. Neonatal nasal obstruction. Eur Arch Otorhinolaryngol 2021; 278:3605-3611. [PMID: 33388986 DOI: 10.1007/s00405-020-06546-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/01/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Congenital nasal obstruction can be a significant cause of respiratory distress in the newborn, given that they are considered to be obligate nasal breathers. Several different causes have been described, which can be broadly classified as anatomical/malformative, non-tumoral masses and cysts, benign and malignant neoplasia, inflammatory/infectious, traumatic/iatrogenic, and miscellaneous. The purpose of this review is to provide updated and useful clinical information for teams involved in neonatal care, especially in a hospital setting. METHODS A review of the available literature was performed. Studies were sourced from PubMed with searching of relevant headings and sub-headings and cross-referencing. RESULTS The most common etiology is inflammatory, which can have different precipitating factors or be idiopathic, a condition known as neonatal rhinitis. On the other hand, some less frequent but nonetheless relevant conditions causing severe nasal obstruction include choanal atresia, midnasal stenosis, and pyriform aperture stenosis. Some cystic lesions, such as dacryocystoceles with intranasal mucocele, can also produce significant obstruction. Diagnosis usually requires a nasal endoscopy and in some cases imaging such as computed tomography. Management includes different medical and surgical strategies and will greatly depend on the etiology and the severity of symptoms. CONCLUSION Congenital nasal obstruction can be a significant cause of respiratory distress in the newborn. The wide spectrum of differential diagnoses requires a thorough knowledge of nasal anatomy, physiology, and pathology; as well as different management strategies.
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Affiliation(s)
- Andrés Alvo
- Otorhinolaryngology Unit, Hospital de Niños Roberto del Río, Santiago, Chile. .,Clínica Alemana de Santiago, Santiago, Chile. .,Department of Otorhinolaryngology. Hospital Clínico, Universidad de Chile, Santos Dumont 999, Independencia, Santiago, Chile.
| | | | - Cecilia Sedano
- Otorhinolaryngology Unit, Hospital de Niños Roberto del Río, Santiago, Chile
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12
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Ali M, Bothra N. Orbital involvement in lacrimal drainage disorders. Saudi J Ophthalmol 2021. [DOI: 10.4103/sjopt.sjop_121_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Akpolat C, Sendul SY, Unal ET, Karatas E, Ucgul Atilgan C, Demir M. Outcomes of lacrimal probing surgery as the first option in the treatment of congenital dacryocystocele. Ther Adv Ophthalmol 2021; 13:25158414211030427. [PMID: 34291188 PMCID: PMC8274130 DOI: 10.1177/25158414211030427] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/16/2021] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To determine the demographic and clinical characteristics of newborn patients who underwent lacrimal probing surgical intervention with or without the marsupialization of intranasal cysts as the primary management for dacryocystocele treatment. METHODS Data from the medical charts of 350 infants who underwent lacrimal probing surgery due to nasolacrimal duct obstruction were reviewed retrospectively. Ten newborn patients with a naive diagnosis of congenital dacryocystocele were included in the study. Congenital dacryocystocele diagnosis was based on a triad of swelling in the inner canthal region, a bluish appearance, and epiphora. Lacrimal probing surgery accompanied by nasal endoscopy was planned for all patients as the first treatment option. RESULTS The mean age of the patients was 24.90 ± 7.15 days, with a range of 6-85 days. A total of 10 patients were included, comprising seven females and three males. The mean postoperative follow-up period was 38.7 ± 24.41 months. Five patients had left, four patients had right, and one patient had bilateral dacryocystocele. Seven eyes of the six patients had uncomplicated dacryocystocele, while the remaining patients had dacryocystocele with complications of dacryocystitis and/or preseptal cellulitis. All patients had intranasal cysts. All patients underwent one session of lacrimal probing surgery under general anesthesia; all with successful outcomes. Four patients with additional dacryocystocele-associated complications underwent combined intranasal marsupialization of the cyst wall. DISCUSSION Lacrimal probing surgery ± intranasal marsupialization of the cyst wall as a first treatment option can be effective for both congenital dacryocystocele and/or congenital dacryocystocele plus associated complications and provide complete resolution of dacryocystocele-related symptoms.
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Affiliation(s)
- Cetin Akpolat
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, Etfal Street Sisli, Istanbul 34280, Turkey
| | - Selam Yekta Sendul
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ebru Turkoglu Unal
- Department of Neonatology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Egemen Karatas
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Cemile Ucgul Atilgan
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Altındag, Ankara, Turkey
| | - Mehmet Demir
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Biadsee A, Dagan O, Kassem F, Ben-Dov T, Ebner Y. Endoscopic marsupialization of nasolacrimal duct cysts under topical anaesthesia: 5 years of a single institute experience. Int J Pediatr Otorhinolaryngol 2020; 138:110303. [PMID: 32805492 DOI: 10.1016/j.ijporl.2020.110303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/02/2020] [Accepted: 08/04/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To present the outcomes of neonatal nasolacrimal duct cysts treated through endoscopic intranasal marsupialization under topical anaesthesia. METHODS A retrospective study of 19 infants diagnosed with congenital nasolacrimal duct cyst, with or without dacryocystocele, diagnosed and treated between March 2015 through March 2020. Data were extracted for descriptive purposes and included: birth weight, main presenting symptom, stertor or dyspnoea, unilateral or bilateral occurrence. Follow-up one month after intervention included recurrence of symptoms, physical examination and fibreoptic naso-endoscopy. RESULTS Nineteen infants with intranasal cyst were presented to our department at the age of 1 day. Four-teen infants had unilateral and 5 infants had bilateral intranasal cysts. There were 8 boys and 11 girls. Mean gestational age at birth was 39 weeks, mean birth weight was 3351 g. 42.1% of infants presented with dacryocystocele, 31.5% with stertor, and 26.3% with dyspnoea. 80% of infants with bilateral cysts presented with dyspnoea. Follow up ranged from 6 to 48 months, no recurrence of symptoms was reported. CONCLUSION Intranasal endoscopic marsupialization under topical anaesthesia is a successful, safe, low cost procedure for treating neonatal nasolacrimal duct cysts while avoiding general anaesthesia for infants.
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Affiliation(s)
- Ameen Biadsee
- Department of Otorhinolaryngology, Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Or Dagan
- Department of Otorhinolaryngology, Head and Neck Surgery, Hillel Yaffe Medical Center, Hadera, Israel.
| | - Firas Kassem
- Department of Otorhinolaryngology, Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Tom Ben-Dov
- Department of Otorhinolaryngology, Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yaniv Ebner
- Department of Otorhinolaryngology, Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Sieck EG, Zukin L, Patnaik JL, Lynch AM, Kelley P, Singh JK. Cost comparison of different treatment approaches of dacryocystitis and dacrocystocele. Ther Adv Ophthalmol 2020; 12:2515841420926288. [PMID: 33103055 PMCID: PMC7550943 DOI: 10.1177/2515841420926288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 03/26/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose Congenital dacrocystocele with potential for dacryocystitis are common ophthalmic findings in children. There are multiple surgical approaches to open the mucocele. In this study, we look at the financial impact of these different approaches. Methods A retrospective chart review of 17 patients with dacrocystocele or dacryocystitis was performed. We examined four approaches: (1) bedside nasal endoscopy with marsupialization of nasolacrimal duct (NLD) cyst, (2) surgically performed nasal endoscopy with marsupialization of NLD cyst, (3) NLD probe, and (4) a combination of procedures. Cost of the procedure and length of anesthesia were collected. Reoccurrence of symptoms and disease post-procedure were also collected. Results The lowest cost billed procedure was bedside nasal endoscopy performed by an otolaryngologist (US$435; n = 1). A nasal endoscopy (n = 2) performed in the operating room (OR) had an average OR fee of US$14,557 [standard deviation (SD): US$7598] for 108.5 (SD: 87.0) min of operating time. An NLD probe (n = 5) performed by pediatric ophthalmologists resulted in an average OR fee of US$5540 (SD: US$1752) for 31.0 min (SD: 8.6 min) of operating time. A combination of both nasal endoscopy and NLD probing (n = 9) had an average OR fee US$10,325 (SD: US$4137) for 69 min (SD: 34.5 min) of operating time. Conclusion This is the first study looking at cost benefit of four different approaches to treating dacrocystoceles/dacryocystitis. A NLD probe was a low-cost OR intervention and had the shortest operating time. The combination procedure was more cost-effective than nasal endoscopy or NLD probing alone.
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Affiliation(s)
- Erin G Sieck
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Leonid Zukin
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jennifer L Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Anne M Lynch
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Peggy Kelley
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jasleen K Singh
- Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court F731, Aurora, CO 80045, USA
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Bonafede L, Go M, Cheng J, Belcastro AA, Bellet JS, Gabr H, Freedman SF, Velez FG. Periocular infantile hemangioma masquerading as dacryocele. J AAPOS 2020; 24:326-328. [PMID: 32693170 DOI: 10.1016/j.jaapos.2020.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/07/2020] [Accepted: 07/13/2020] [Indexed: 11/18/2022]
Abstract
A 2-month-old boy developed a protuberant, blue nodule inferomedial to the left medial canthus. It was unresponsive to oral and intramuscular antibiotics. After developing difficulty breathing, he was admitted, with the diagnosis of a dacryocele, and, after an inconclusive ultrasound, underwent probing and irrigation with nasal endoscopy. Intraoperatively, the lesion appeared discontinuous with the nasolacrimal system and could not be decompressed. Postoperative magnetic resonance imaging suggested a hemangioma or possible collapsed dacryocele. Doppler ultrasound confirmed a perinasolacrimal duct hemangioma. Systemic propranolol treatment was initiated.
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Affiliation(s)
- Lucas Bonafede
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Michelle Go
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Jeffrey Cheng
- Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - Alexandra A Belcastro
- Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - Jane S Bellet
- Departments of Dermatology and Pediatrics, Duke University, Durham, North Carolina
| | - Hesham Gabr
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Sharon F Freedman
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Federico G Velez
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
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Bothra N, Wagh RD, Ali MJ. Masquerades of Acquired Dacryocystocele. Clin Ophthalmol 2020; 14:1855-1858. [PMID: 32753833 PMCID: PMC7342387 DOI: 10.2147/opth.s261098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 06/23/2020] [Indexed: 12/01/2022] Open
Abstract
Introduction Dacryocystocele can be congenital or acquired and acute or chronic, based on underlying pathology. An inferomedial anterior orbital mass lesion can masquerade an acquired dacryocystocele with similar symptomatology; however, the treatment varies. Hence, a careful examination of the swelling to differentiate these masquerades is needed to ensure rightful treatment. Patients and Methods A retrospective, interventional study was performed on consecutive patients from January 2017 to October 2019 who presented with swelling in the lacrimal sac area of varying durations. They underwent computed tomography scans followed by surgical intervention. Their relation to the lacrimal drainage apparatus was explored. Results During the study period, 5 such patients were found in the records. The radiology was consistent with anterior orbital mass lesions, not involving the lacrimal sac. Histopathology after surgical excision was consistent with three of the lesions being dermoid cysts, one was cavernous hemangioma and one was a solitary fibrous tumor. Conclusion Inferomedial anterior orbital mass lesions can present as masquerades of acquired dacrycystoceles. Careful examination and high degree of suspicion is needed to distinguish these lesions and ensure correct treatment.
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Affiliation(s)
- Nandini Bothra
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad 500034, Telangana, India
| | - Richa Dharap Wagh
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad 500034, Telangana, India
| | - Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad 500034, Telangana, India
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18
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Ladeiras R, Nunes JS, Torres S, Duarte C, Pereira E, Rosmaninho A. An Ultrasound Diagnosis of a Congenital Periorbital Rare Condition. J Med Ultrasound 2020; 29:142-143. [PMID: 34377653 PMCID: PMC8330682 DOI: 10.4103/jmu.jmu_42_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/18/2020] [Accepted: 04/28/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- Rita Ladeiras
- Department of Gynecology and Obstetrics, Hospital Senhora da Oliveira, Guimarães, Braga, Portugal
| | - Joana Sousa Nunes
- Department of Gynecology and Obstetrics, Hospital Senhora da Oliveira, Guimarães, Braga, Portugal
| | - Sílvia Torres
- Department of Gynecology and Obstetrics, Hospital Senhora da Oliveira, Guimarães, Braga, Portugal
| | - Carla Duarte
- Department of Gynecology and Obstetrics, Hospital Senhora da Oliveira, Guimarães, Braga, Portugal
| | - Elsa Pereira
- Department of Gynecology and Obstetrics, Hospital Senhora da Oliveira, Guimarães, Braga, Portugal
| | - Adosinda Rosmaninho
- Department of Gynecology and Obstetrics, Hospital Senhora da Oliveira, Guimarães, Braga, Portugal
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Wegman SJ, McKnight L. Case 2: Recurrent Respiratory Distress in a Newborn. Pediatr Rev 2020; 41:297-299. [PMID: 32482693 DOI: 10.1542/pir.2018-0259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Lucas McKnight
- The Ohio State University, Columbus, OH.,Nationwide Children's Hospital, Columbus, OH
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Abstract
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.
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Zhao NW, Chan DK. Awake bedside nasal endoscopy for primary management of neonatal dacryocystoceles with intranasal cysts. Int J Pediatr Otorhinolaryngol 2019; 123:93-96. [PMID: 31085463 DOI: 10.1016/j.ijporl.2019.04.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/09/2019] [Accepted: 04/30/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To present outcomes of neonatal dacryocystoceles treated through endoscopic intranasal cyst marsupialization (EICM) without general anesthesia and nasolacrimal duct (NLD) probing or irrigation. METHODS Records of eleven consecutive infants diagnosed with unilateral or bilateral congenital cysts associated with the nasolacrimal system between January 2016 and February 2019 at our institution were retrospectively reviewed. RESULTS Age at diagnosis ranged from 0 to 56 days, and 45.5% were male. 54.5% had dacryocystitis before surgical intervention. Patients were initially treated with a combination of massage and topical antibiotics; some received parenteral antibiotics if infected. Nearly all patients (90.9%) had one or more intranasal cysts. Of these patients, two underwent lacrimal probing and EICM in the operating room. One underwent EICM only in the operating room. Another patient initially failed bedside NLD probing and subsequently underwent bedside nasal endoscopy and awake EICM. The final six patients underwent EICM without general anesthesia or NLD probing. No complications were noted. Follow-up ranged from 7 to 906 days. Complete resolution was observed in all ten patients who underwent EICM, regardless of anesthesia. CONCLUSIONS Neonatal dacryocystoceles and/or intranasal cysts are successfully treated at the bedside through nasal endoscopy with simple awake endoscopic intranasal cyst marsupialization. Avoidance of general anesthesia and NLD probing or irrigation would greatly simplify and decrease the cost of dacryocystocele management.
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Affiliation(s)
- Nina W Zhao
- Department of Otolaryngology - Head and Neck Surgery, University of California - San Francisco, San Francisco, CA, USA
| | - Dylan K Chan
- Department of Otolaryngology - Head and Neck Surgery, University of California - San Francisco, San Francisco, CA, USA.
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Bou Ghannam AS, Mhanna CJ, Atallah M, Alameddine RM. Bilateral Blue Masses. J Pediatr Ophthalmol Strabismus 2019; 56:8. [PMID: 30673100 DOI: 10.3928/01913913-20181206-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Sarbajna T, Takahashi Y, Paula Valencia MR, Ana-Magadia MG, Ishikawa E, Kakizaki H. Dacryoendoscopy-assisted nasal endoscopic marsupialization for congenital dacryocystocele. Int J Pediatr Otorhinolaryngol 2018; 115:54-57. [PMID: 30368393 DOI: 10.1016/j.ijporl.2018.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/16/2018] [Accepted: 09/16/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the surgical outcome of dacryoendoscopy-assisted nasal endoscopic marsupialization for congenital dacryocystocele. METHODS This is a retrospective, observational study that included 7 sides of 6 patients with congenital dacryocystocele. The surgical indication in 5 of the patients was acute dacryocystitis while one of the patients had no spontaneous resolution after long-term observation. Dacryoendoscopy was used for visualisation of the lacrimal cavity, direct probing of the obstruction at the common canaliculus, and localisation of a deflated intranasal cyst after an initial incision of the cyst. Surgical success was defined when the following postoperative conditions were satisfied: no epiphora, normal tear meniscus height, and complete clearance of the dye 5 min after instilling a drop of 2% fluorescein solution into the inferior conjunctional fornix. RESULTS Out of 6 patients, 2 patients were noted to have membranous common canalicular obstruction. Postoperative follow-up ranged from 11 days to 3 months. Surgical success was achieved in all patients without any complication. CONCLUSIONS Dacryoendoscopy-assisted nasal endoscopic marsupialization is an effective surgical management for congenital dacryocystocele.
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Affiliation(s)
- Tushar Sarbajna
- Department of Oculoplastic, Orbital, and Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Yasuhiro Takahashi
- Department of Oculoplastic, Orbital, and Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan.
| | - Ma Regina Paula Valencia
- Department of Oculoplastic, Orbital, and Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Marian Grace Ana-Magadia
- Department of Oculoplastic, Orbital, and Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Eri Ishikawa
- Department of Oculoplastic, Orbital, and Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Hirohiko Kakizaki
- Department of Oculoplastic, Orbital, and Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
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Focal epilepsy as a late complication of congenital dacryocystocele. Seizure 2018; 60:157-158. [DOI: 10.1016/j.seizure.2018.06.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 06/28/2018] [Accepted: 06/30/2018] [Indexed: 11/18/2022] Open
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