Abstract
Objective: To provide information on the clinical characteristics and management of an uncommon acquired nasolacrimal drainage system obstruction (NLDSO).Methods: A patient was treated with microdebrider-assisted endoscopic marsupialization for a cystic lesion located in the synechiae between the inferior turbinate and the lateral wall of the inferior meatus.Results: A 21-year-old woman suffered from epiphora and purulent discharge 1 week after inferior turbinate surgery. Endoscopy reveled synechiae between the inferior turbinate and the lateral wall of the inferior meatus. Computed tomography-dacrocystography (CT-DCG) showed enlargement of the nasolacrimal duct and cystic accumulation of contrast medium from the lacrimal orifice posteriorly. The patient was treated with nasal endoscopic marsupialization of the cyst and then powered inferior turbinoplasty. Six months after the operation, both endoscopy and CT scan showed a widely patent left inferior meatus and nasolacrimal orifice.Conclusions: We report the first case of post-operative NLDSO following inferior turbinate surgery. Nasal endoscopy and CT-DCG are useful to diagnose the location of a NLDSO. Otorhinolaryngologists should be aware that surgery may lead to the formation of a NLDSO and that endoscopic marsupialization is a curative treatment for these distal-end NLDSO. NLDSOs are caused by synechiae, which are a complication of inferior turbinate surgery.
Highlights
Inferior turbinate hypertrophy is one of the main causes of chronic nasal obstruction and can have an allergic, infectious or vasomotoric etiology
Upon introduction of the endoscopic sinus surgery (ESS) technique [4], the most likely sites of injury to the nasolacrimal drainage system were reported to be to the lacrimal duct during enlargement of the middle meatus antrostomy anteriorly with backbiting forceps or to the lacrimal sac during the initial lateral nasal wall incision with a sickle knife
Our patient, nasolacrimal drainage system obstruction (NLDSO) might be caused by synechiae, which are a complication of inferior turbinate surgery
Summary
Inferior turbinate hypertrophy is one of the main causes of chronic nasal obstruction and can have an allergic, infectious or vasomotoric etiology. Inferior turbinate surgery is widely performed to treat this disease. Complications of inferior turbinate surgery are rare [1], but bleeding and crusting are the most frequently described complications. Synechiae, anosmia, atrophic rhinitis, and empty nose syndrome are other rare complications. We report the first case, to our knowledge, of post-operative nasolacrimal drainage system obstruction (NLDSO) following inferior turbinate surgery
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