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Nasolacrimal Duct Cyst

Dacryocystocele


Presentation

  • The authors report a series of 8 children presenting with a congenital nasolacrimal duct cyst and dacryocoele and highlight the importance of endoscopic nasal examination of newborns presenting with respiratory problems.[ncbi.nlm.nih.gov]
  • From Wikipedia, the free encyclopedia Jump to navigation Jump to search Nasolacrimal duct cyst Specialty Dermatology Nasolacrimal duct cysts are a cutaneous condition that is a developmental defect present at birth. [1] See also [ edit ] Skin dimple List[en.wikipedia.org]
  • The presentation is common early in infancy, typically 4 days to 10 weeks. Infants present with small round bluish medial canthus mass identified at birth or shortly after /- distal intra-nasal cystic lesion causing nasal obstruction.[radiopaedia.org]
  • Discussion Presentation of congenital dacryocystocele Congenital dacryocystocele, also known as a dacryocele, often presents shortly after birth.[webeye.ophth.uiowa.edu]
  • Unilateral cases present with unilateral nasal obstruction and rhinorrhea. Bilateral cases present with severe respiratory distress requiring prompt intervention.[csurgeries.com]
Poor Feeding
  • Because infants are preferential nose breathers, this displacement can cause significant respiratory distress, manifested as cyanosis, labored breathing, and poor feeding. (4) These symptoms usually diminish with crying, and they can be temporarily relieved[thefreelibrary.com]
Mucosal Edema
  • Nasal endoscopy at 3 days of age revealed nasal mucosal edema and mild right choanal stenosis. He was treated with nasal oxymetazoline drops, and his respiratory symptoms resolved.[healio.com]
Intravenous Administration
  • administration of contrast material may demonstrate slight enhancement of the cyst wall that is more pronounced in dacryocystitis.[radiopaedia.org]
Feeding Difficulties
  • Basic Info The patient is a 4 week old female infant with right sided epiphora and complete right sided nasal obstruction resulting in respiratory and feeding difficulty.[csurgeries.com]
Respiratory Distress
  • Nasolacrimal duct abnormality should be considered in the differential diagnosis of neonatal respiratory distress and nasal obstruction. Nasal endoscopy is essential in the work-up of all children with nasal obstruction and respiratory distress.[ncbi.nlm.nih.gov]
  • His respiratory distress increased with feeding, and he was feeding poorly. His arterial blood gas level was normal.[thefreelibrary.com]
  • Nasal obstruction was present in three infants and was severe enough to cause respiratory distress in two neonates with bilateral cysts.[ncbi.nlm.nih.gov]
  • Bilateral nasolacrimal duct mucocele, a rare cause of respiratory distress: CT findings in two newborns. AJNR Am J Neuroradiol. 1993 Jul-Aug;14(4):1011-3. Meyer JR, Quint DJ, Holmes JM, Wiatrak BJ.[roentgenrayreader.blogspot.com]
  • Bilateral cases present with severe respiratory distress requiring prompt intervention.[csurgeries.com]
Labored Breathing
  • Because infants are preferential nose breathers, this displacement can cause significant respiratory distress, manifested as cyanosis, labored breathing, and poor feeding. (4) These symptoms usually diminish with crying, and they can be temporarily relieved[thefreelibrary.com]
Tachypnea
  • On admission, the infant had increased work of breathing including tachypnea, nasal flaring and retractions. On the initial chest radiograph, the NG tube was not seen even though it was in the left nare at 10 cm.[nature.com]
Respiratory Insufficiency
  • Associated intranasal cyst (Fig. 12.7 ) can be small or large (if 50 of the nasal cavity) and, if large, can cause respiratory insufficiency because infants are nasal breathers, which can be life-threatening in cases of bilateral pathology [ 11 ].[entokey.com]
Aspiration
  • If the child is anesthetized the saline (colored with fluoroscein typically) can be aspirated with suction. The end of the probe can sometimes be directly observed.[eyewiki.aao.org]
Cyanosis
  • Because infants are preferential nose breathers, this displacement can cause significant respiratory distress, manifested as cyanosis, labored breathing, and poor feeding. (4) These symptoms usually diminish with crying, and they can be temporarily relieved[thefreelibrary.com]
Anisocoria
  • No anisocoria and no relative afferent pupillary defect Intraocular pressure: Physiologic by palpation Alignment : Ortho by Hirschberg Anterior segment exam : Within normal limits Dilated funduscopic exam : Deferred until examination under anesthesia[webeye.ophth.uiowa.edu]
Impulsivity
  • Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years C. Some impairment from the symptoms is present in two or more settings (eg, at school (or work) and at home) D.[books.google.com]
Distractibility
  • Mandible Distraction in Infancy Jocelyn M. Shand 35. Mandible Distraction for Cranial Conditions Cesar Guerrero 36. The Anterior Segmental Maxillary Osteotomy Dror M. Allon and Neeraj Panchal 37. SARPE Jessica Lee 38.[euro-libris.ro]
Hyperactivity
  • Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years C. Some impairment from the symptoms is present in two or more settings (eg, at school (or work) and at home) D.[books.google.com]

Workup

  • Neoplasm [ edit ] Neoplasm should be considered in any patient presenting with NLD obstruction.In patients with an atypical presentation, including younger age and male gender, further workup is appropriate.[en.wikipedia.org]
Periostal Elevation
  • The inferior turbinate was infractured using a Freer periosteal elevator if additional space was required. Following marsu piali zation of the cyst, the Bowman probe was visualized coming through the distal valve of Hasner (Fig 4C).[healio.com]
  • elevator depending on the view and space available for manipulation in the inferior meatus.[djo.org.in]

Treatment

  • Endoscopic marsupialization followed by lacrimal duct irrigation is effective in the treatment of congenital nasolacrimal duct cyst and results in complete resolution of symptoms.[ncbi.nlm.nih.gov]
  • Conclusions Microdebrider assisted endoscopic marsupialisation is a safe and effective treatment for removal of excess tissue in the treatment for congenital intranasal NLD cyst/inferior mucocoele whilst also obviating the need for silastic intubation[link.springer.com]
  • Treatment and prognosis Treatment of dacryocystoceles is graded and ranges from manual pressure to probing with irrigation to endoscopic resection and marsupialization in severe cases.[radiopaedia.org]
  • Sepsis is a life threatening complication if the infection goes without treatment.[webeye.ophth.uiowa.edu]
  • Early diagnosis and treatment of this condition is critical in the infant with nasal obstruction.[ncbi.nlm.nih.gov]

Prognosis

  • Treatment and prognosis Treatment of dacryocystoceles is graded and ranges from manual pressure to probing with irrigation to endoscopic resection and marsupialization in severe cases.[radiopaedia.org]
  • (Outcomes/Resolutions) Overall, the prognosis of Blocked Tear Duct is very good with appropriate therapy. In infants, usually, the blocked duct gets better by its own.[dovemed.com]
  • Prognosis Overall prognosis is excellent. More than 90% of children with these developmental anomalies have improved subjective tearing postoperatively. Moscato EE, Kelly JP, Weiss A.[emedicine.medscape.com]
  • Prognosis : dependent upon primary cause.[vetstream.com]
  • Prognosis The prognosis for resolution of nasolacrimal duct obstruction by one or more surgical procedures is quite good. The success rate of simple probing is excellent.[eyewiki.aao.org]

Etiology

  • Embryology Etiology / Pathogenesis Ultrasound Differential Diagnosis[fetalultrasound.com]
  • The etiology is obstruction at the level of Hassner's valve. Advanced Procedure 1. Lidocaine with epinephrine pledgelets are placed in the nasal cavity around the nasal mass and inferior turbinate 2.[csurgeries.com]
  • […] softer to touch Encephalocele: Usually superior to medial canthal tendon Dermoid: Usually superior to medial canthal tendon Nasal glioma Complications Dacryocystitis Cellulitis Respiratory compromise Sepsis CT or MRI should be performed if more serious etiology[webeye.ophth.uiowa.edu]
  • Pathogenesis Etiology Internal Dacryocystitis Eye: dacryocystitis - inflammation of the nasolacrimal sac and duct often secondary to: Foreign bodies, eg plant material and dust/debris Conjunctivitis: foreign body.[vetstream.com]
  • Acquired lacrimal drainage obstruction: an etiologic classification system, case reports, and a review of the literature. Part 2. Ophthal Plast Reconstr Surg. 1992. 8(4):243-9. [Medline]. Bartley GB.[emedicine.medscape.com]

Epidemiology

  • Diagnosis: Congenital Dacryocystocele Epidemiology Presents within first several days to weeks of life (median age 7 days of life)[2] Usually unilateral Signs Elevated purplish mass inferior to medial canthal tendon Epiphora, mattering (generally unilateral[webeye.ophth.uiowa.edu]
  • In this article, we shall briefly review the epidemiology, clinical presentation and the common causes of this condition. Epidemiology Clinical research has shown that nasolacrimal duct obstruction occurs in 2 to 4 out of 100 newborn babies.[eyeplastics.com]
  • Definition / general A rare, developmental non-odontogenic cyst that occurs in the soft tissues of the upper lip lateral to midline Terminology Klestadt cyst Nasal alveolar cyst Nasoalveolar cyst Nasal wing cyst Nasal vestibule cyst Mucoid cyst of the nose Epidemiology[pathologyoutlines.com]
  • Pathophysiology Canalization of the nasolacrimal duct system usually is complete by the eighth month of gestation; problems in this normal developmental process can cause any of the above anomalies. [1] Epidemiology Frequency United States Nasolacrimal[emedicine.medscape.com]
  • Epidemiology Frequency United States Nasolacrimal drainage obstruction is relatively common, but the exact frequency is not known. International The incidence rate worldwide is unknown.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Stenosis and/or occlusion of the nasolacrimal duct system may occur as an acquired complication of various disease processes within the drainage system or external to it.[vetstream.com]
  • Pathophysiology Canalization of the nasolacrimal duct system usually is complete by the eighth month of gestation; problems in this normal developmental process can cause any of the above anomalies. [1] Epidemiology Frequency United States Nasolacrimal[emedicine.medscape.com]
  • Pathophysiology/Statistics Although quite common, the frequency of nasolacrimal drainage obstruction is unknown. It has no racial predilection. PANDO is more commonly seen in middle-aged and elderly females.[eyeplastics.com]
  • In addition, information is included concerning the pathophysiology and pathology of the disorders being discussed, and some basic information concerning the causative genes (when appropriate).[euro-libris.ro]
  • […] nasolacrimal duct obstruction caused by inflammation or fibrosis without any precipitating cause. [1] Bartley proposed an etiologic classification system for secondary acquired lacrimal drainage obstruction (SALDO) based on published cases. [2, 3, 4] Pathophysiology[emedicine.medscape.com]

Prevention

  • The procedure with the microdebrider was carefully performed to prevent injury to the surrounding tissue. Nasal packing to prevent bleeding was not necessary.[jstage.jst.go.jp]
  • Role of topical antibiotics: Topical antibiotics can be used to prevent secondary conjunctivitis. Warm compresses, lacrimal massage, probing of lacrimal duct can be performed to facilitate drainage of tears.[sites.google.com]
  • These were treated by endoscopic incision of the cyst with drainage of pus and excision of excess mucosal tissue using a powered microdebrider to effect marsupialisation and prevent re healing of the floppy redundant flaps of the incised cyst.[link.springer.com]
  • For the same reason when applying some eye drops it is often advised to close the nasolacrimal duct by pressing it with a finger to prevent the medicine from escaping the eye and having unwanted side effects elsewhere in the body.[en.wikipedia.org]
  • A tiny plastic tube (Jones tube) is then placed in the newly created tear drainage pathway to prevent scarring of the tear drainage duct, which might otherwise result in failure of the surgery.[mosesmousereye.com]

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