Neonatal dacryocele with endonasal cyst: revisiting the management☆☆☆
Received 4 November 2009 published online 11 January 2010. Corrected Proof
Abstract
Purpose
The aim of the study was to present a consecutive series of neonatal dacryocele with endonasal cyst diagnosed and treated in our institution and to compare our management regimen and outcome with those reported in the literature.
Methods
The study was conducted at a university-affiliated teaching hospital. Study population included 5 infants, ages 1 day to 1 month, with either noninfected or infected neonatal dacryocele with endonasal cyst. Management included antibiotic treatment (topical and/or systemic) and local lacrimal massage. When conservative treatment failed, endoscopic identification and incision of the endonasal cyst with subsequent lacrimal duct irrigation with fluorescein and antibiotics were carried out in the office. Main outcome measures included resolution of symptoms and recurrence rate.
Results
Between the years 2003 and 2007, 5 infants were diagnosed and treated. All had unilateral dacryocele with endonasal cyst. Female-to-male ratio was 4:1. Age ranged from 1 day to 1 month old. Three had dacryocystitis (60%) before treatment. None had symptoms of airway obstruction. One patient was successfully treated conservatively with firm massage by the ophthalmologist resulting in rupture of the endonasal cyst and did not require further treatment. Four patients were treated with a combined ophthalmology/otolaryngology surgical procedure. All patients were treated in an office setting without general anesthesia. One patient underwent computed tomographic imaging before treatment to confirm the diagnosis. Follow-up ranged from 1 month to 50 months with an average of 23 months. Complete resolution was observed in all patients without recurrence and without complications.
Conclusions
We report on the successful surgical treatment of neonatal dacryocele with endonasal cyst in an office setting without the use of general anesthesia, using endoscopic incision of the cyst and irrigation alone. The high success rate of this relatively benign office procedure encourages its use and further supports the approach of early surgical intervention, thus, helping to avoid infectious complications that can be severe at this age.
aDepartment of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Affiliated with the Hebrew University—Hadassah Medical School, Jerusalem, Israel
bDepartment of Ophthalmology, Head of Pediatric Ophthalmology and Neuroophthalmology Unit, Kaplan Medical Center, Rehovot, Affiliated with the Hebrew University—Hadassah Medical School, Jerusalem, Israel
Corresponding author. Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, P.O. Box-1, Rehovot, Israel. Tel.: +972 8 9441649; fax: +972 8 9441794.
☆ Each of the authors has contributed to, read and approved this manuscript. This manuscript, or any part of it, has not been previously published, and it is not under consideration elsewhere.
☆☆ The authors did not receive grant or any support regarding this article. The authors have no relevant financial interest in this article.
ABSTRACT