Intranasal Cysts Research Articles

Probing versus primary nasal endoscopy for the treatment of congenital dacryocystoceles

To compare outcomes and complications of three surgical techniques for the treatment of congenital dacryocystoceles: nasolacrimal probing and irrigation (P+I), P+I plus nasal endoscopy (NE) with intranasal cyst marsupialization, and primary NE with intranasal cyst marsupialization. The medical records of children ≤2 years of age at a single academic center with a diagnosis of dacryocystocele from 2012 to 2022 were retrospectively identified and reviewed. The primary outcome was resolution of the dacryocystocele (ie, elimination of the medial canthal mass and resolution of tearing or discharge) after a single procedure ("primary success"). Surgical techniques were compared using exact logistic regression. Of 54 patients, 21 (39%) underwent P+I, 23 (43%) underwent P+I plus nasal endoscopy, and 10 (18%) underwent primary NE. Primary success was 76% for P+I and 100% for the other two cohorts. Most patients (89%) who underwent P+I received general anesthesia compared with none who underwent primary nasal endoscopy. Most complications were related to the use of general anesthesia, with a complication rate of 10% for P+I, 48% for P+I plus NE, and 0% for primary NE. Most P+I procedures required hospital admission compared to half of primary NE procedures. In our study cohort, primary NE provided good outcomes and was associated with a lower complication rate than P+I with or without NE.

Microdebridement of Intranasal Cysts Associated With Congenital Dacryocystoceles.

The surgical management of congenital dacryocystoceles has evolved in recent decades. The aim of this study was to explore the effectiveness of endoscopic examination and powered microdebridement in the management of nasal cysts associated with congenital dacryocystoceles. In this retrospective case series, all patients with congenital dacryocystoceles who underwent surgical intervention under general anesthesia at a single institution over a 12-year period (2009-2020) were included. Thirty-seven lacrimal drainage systems from 29 patients were included, 8 patients (28%) had bilateral dacryocystoceles. Twenty-two (76%) were females, and 5 (17%) patients had a history of prematurity. Mean (±SD) age at diagnosis was 15 ± 28 days, and 1.4 ± 1.7 months at surgical intervention. Mean follow-up was 7.5 months. The right side was more commonly involved (20 [69%] OD vs. 17 [59%] OS). Dacryocystitis was diagnosed at presentation in 23 lacrimal drainage systems (62%). Intraoperatively, intranasal cysts were observed in 32 lacrimal drainage systems (86%), and a powered microdebrider was used to excise each cyst. In 6 of the 21 supposed unilateral cases (29%), a contralateral cyst was identified and treated. The average birth age of patients with intranasal cysts was 39 weeks versus 36 weeks of patients without ( p = 0.03). Surgical success was found in 36 of 37 sides treated (97%); one case (3%) underwent unilateral endoscopic dacryocystorhinostomy during the follow-up period due to persistent symptoms. Congenital dacryocystoceles are associated with intranasal cysts in most cases. Surgical intervention with microdebrider is associated with a favorable outcome. Bilateral endonasal examination is ideal in all cases.

Congenital Nasolacrimal Duct Obstruction Update Study (CUP Study): Paper 4-Infantile Acute Dacryocystitis (InAD)-Presentation, Management, and Outcomes.

To study the presentation, management, and outcomes of infantile acute dacryocystitis. Retrospective study of infants diagnosed with acute dacryocystitis over a period from June 2016 to December 2019. Data collected include demographics, clinical history, presenting features, management, complications, and outcomes. Treatment provided was intensive medical care followed by early probing under endoscopic guidance. Further interventions, where needed, were performed based on intraoperative findings during probing. Successful outcomes were defined as resolution of infection, subjective relief from epiphora, and anatomical patency determined by a normal fluorescein dye disappearance test. Twenty-seven eyes of 27 infants were analyzed during the study period. The mean age of infants was 3.26 months, and males were more affected than females (male:female 15:12). The mean duration of symptoms was 4.66 weeks, with 96% (26/27) presenting with symptoms of redness, watering, discharge, and swelling. Preseptal cellulitis was seen in 74% (20/27) infants, lacrimal abscess in 67% (18/27) infants, and lacrimal fistula in 37% (10/27). Most infants had complex congenital nasolacrimal duct obstruction (62%, 13/27), of which 7 also had intranasal cysts. One infant successfully underwent endoscopic dacryocystorhinostomy. At a mean follow-up period of 7.95 months, successful outcomes were observed in 90.4% (19/21) infants. The 2 failed cases were complex congenital nasolacrimal duct obstruction with associated sac diverticula and are scheduled for an endoscopic dacryocystorhinostomy. Infantile acute dacryocystitis is a distinct clinical entity. The outcomes of systemic antibiotics and early probing are excellent.

Management of Pediatric Acute Dacryocystitis.

To analyze the clinical presentation, course, and management in a large cohort of pediatric acute dacryocystitis subjects and to examine whether hospitalization and urgent surgical intervention are indeed mandatory. A retrospective analysis of all pediatric subjects diagnosed with dacryocystitis at the Children's Hospital of Philadelphia over a 12-year period (2009-2020). One-hundred sixty-nine pediatric acute dacryocystitis patients were included in this study. Management included admission in 117 cases (69%). Sixty-eight patients (40%) were treated medically with no surgical intervention, 75 cases (44%) required urgent surgical intervention, and 26 additional cases (15%) required surgery due to persistent tearing symptoms after medical management. The urgent procedures included most commonly: 1) endonasal examination and microdebridement of intranasal cysts in 26 cases (35%); 2) probing and irrigation without examination and microdebridement, with or without stent intubation, in 30 cases (40%); and 3) dacryocystorhinostomy (13 endonasal and 4 external) in 17 cases (23%). Management of pediatric acute dacryocystitis should be tailored individually for each case. Hospital admission and early surgical intervention are not mandatory, as 31% of cases resolved without admission, and 56% without early surgical intervention. Although a specific age cutoff is not plausible, hospital admission for younger patients is more commonly advocated. When surgical intervention is indicated, endonasal examination and microdebridement of any associated intranasal cyst and probing with possible stenting are the initial procedures of choice. Dacryocystorhinostomy is reserved for more complex obstructions. Although pediatric acute dacryocystitis is an infection with serious potential problems, when managed appropriately, complications are rare.

Outcomes of lacrimal probing surgery as the first option in the treatment of congenital dacryocystocele.

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.

Endoscopic marsupialization of nasolacrimal duct cysts under topical anaesthesia: 5 years of a single institute experience

ObjectiveTo present the outcomes of neonatal nasolacrimal duct cysts treated through endoscopic intranasal marsupialization under topical anaesthesia. MethodsA 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. ResultsNineteen 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. ConclusionIntranasal endoscopic marsupialization under topical anaesthesia is a successful, safe, low cost procedure for treating neonatal nasolacrimal duct cysts while avoiding general anaesthesia for infants.

Unilateral congenital dacryocele

We report a case of a healthy, full term, 3 months old boy, with was referred for evaluation a bluish-gray cystic firm mass approximately mesuring 1-cm just below the medial canthal tendon of the right eye, present since birth. Diagnosis of unilateral congenital dacryocele have been made confirmed by CT-scan. In our case the dacryocele resolved after medical treatment wich inclouded: massage ,warm compresses, antibiotics drops. We did not have recur over 10 months of follow-up. Congenital dacryocele, also known as nasolacrimal mucocele, it is a rare form of congenital distension of the naso-lacrimal sac with both proximal and distal obstruction usually unilateral (Approximately 25% are bilateral), It is typically present at birth or in the first three months of life. Dacryoceles occur in 0.08% to 0.1% of newborns with congenital nasolacrimal duct obstruction. And patients may also have respiratory distress secondary to the intranasal cyst. Differential diagnosis includes encephalocele, capillary hemangioma, glioma and dermoid cyst. Nasolacrimal mucocele can resolves spontaneously in majority of cases with medical treatment which includes antibiotics, warm compresses, and sac massage. However, surgical treatment may be necessary when self-resolution fails, to avoid infectious complication such as of dacryocystitis and preseptal cellulitis.

Congenital Dacryocystocele: A Major Review.

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

Awake bedside nasal endoscopy for primary management of neonatal dacryocystoceles with intranasal cysts

ObjectiveTo present outcomes of neonatal dacryocystoceles treated through endoscopic intranasal cyst marsupialization (EICM) without general anesthesia and nasolacrimal duct (NLD) probing or irrigation. MethodsRecords 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. ResultsAge 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. ConclusionsNeonatal 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.

Computed tomography for guidance in the diagnosis and surgical correction of recurrent pediatric acute dacryocystitis.

ImportanceThis is the first retrospective study of the effect of computed tomography (CT) in diagnosis and surgical correction of recurrent pediatric acute dacryocystitis (PAD).ObjectiveTo explore the pathogenesis of recurrent PAD and the impact of CT in guidance of surgical planning.MethodsMedical histories, clinical manifestations, and CT results of 10 patients with recurrent PAD were reviewed. Etiologies and treatment effectiveness were recorded for all patients.Results CT revealed that three patients had congenital dacryocystocele with lacrimal sac cyst, enlargement of the nasolacrimal canal, and intranasal cyst of affected sides. After regression of local inflammation, marsupialization was performed. CT showed that four patients had PAD secondary to congenital nasolacrimal canal dysplasia; these patients exhibited normal upper portions of the nasolacrimal canals, but had stenotic or atretic middle and terminal segments. After improvement of local inflammation, endonasal dacryocystorhinostomy was performed. Three patients had PAD secondary to congenital lacrimal sac diverticulum; after contrast injection, CT showed that the cysts at the lacrimal sac area were filled with contrast, and were connected to the normal lacrimal sac. After the topical infection was controlled, transcutaneous dacryocystorhinostomy was performed in combination with excision of the lacrimal sac diverticulum. No recurrence of PAD was detected at 6‐month follow‐up.InterpretationCauses of PAD include congenital dacryocystocele, congenital lacrimal sac diverticulum, or congenital nasolacrimal canal dysplasia. Marsupialization with endoscope, endonasal dacryocystorhinostomy, and transcutaneous dacryocystorhinostomy constitute distinct surgeries for PAD treatment. CT provides an important diagnostic function and facilitates selection of specific surgical approaches for recurrent PAD.

Dacryoendoscopy-assisted nasal endoscopic marsupialization for congenital dacryocystocele

ObjectiveTo examine the surgical outcome of dacryoendoscopy-assisted nasal endoscopic marsupialization for congenital dacryocystocele. MethodsThis 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. ResultsOut 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. ConclusionsDacryoendoscopy-assisted nasal endoscopic marsupialization is an effective surgical management for congenital dacryocystocele.

Bilateral congenital dacryocystocele-A case report

Congenital dacryocystocele is a rare congenital anomaly of the lacrimal drainage system (0.02% of newborns), which refers to the cystic dilatation of the lacrimal sac and nasolacrimal duct. In most cases the pathology is unilateral with female predominance. Bilateral cases constitute 10% of all cases and in most babies with bilateral disease there are coexistent nasal cysts. Clinically, dacryocystocele presents as a grey-bluish cystic swelling of the lacrimal sac in the medial canthal area that typically present at birth and often resolve spontaneously with conservative management in the first months of life. Bilateral cases of congenital dacryocele are rarely reported, especially isolated dacryocystoles without coexistent nasal cysts. We present a rare case of bilateral congenital dacryocystocele in a 10-day-old newborn boy, without concomitant intranasal cysts. The infant was treated conservative with spontaneous resolution of the disease 6 weeks after treatment initialization. No dacryocystitis or preseptal cellulitis was observed, nevertheless rupturing of the dacryocystocele to the common canaliculus.

First intraoperative experience with three-dimensional (3D) high-definition (HD) nasal endoscopy for lacrimal surgeries.

The aim of this study is to report our preliminary experiences with regard to safety and feasibility of three-dimensional (3D) endoscopic lacrimal surgeries with a recently launched latest generation 3D endoscope. A 4-mm rigid three-dimensional (3D) endoscope (TIPCAM 1S 3D ORLR, Karl Storz, Tuttlingen, Germany) was used. Fifteen patients who underwent various endoscopic lacrimal procedures by a single surgeon (MJA) were included. The procedures included probing with nasolacrimal intubation, cruciate marsupialization of intranasal cysts for congenital dacryoceles, powered endoscopic dacryocystorhinostomy, post-operative stent removal with ostium granuloma excision. The implementation, visualization, optical performance, ease of tissue handling and complications were noted. Ten surgical observers filled a questionnaire to rate their experiences. Enhanced depth perception was found to be very beneficial intraoperatively. Greater anatomical delineation facilitated improved hand-eye coordination and dexterity. Intraoperative assessment and handling of tissues and surgical manoeuvring were precise and did not require the additional spatial cues that the surgeon derives from a two-dimensional image. These benefits were more appreciated in the complex cases. The setup was easy on previous endoscopic platforms and did not consume any additional time. All the surgical procedures were completed successfully without any complications. The surgical observers unanimously noted enhanced anatomical understanding and surgical learning as compared to the routine 2D planes. Operating in 3D planes enhances depth perception, dexterity and precision. Although initial results are promising, further randomized studies with head-on comparisons between 3D and 2D would help formulate specific guidelines.

Clinical Outcome of Probing in Infants with Acute Dacryocystitis - A Prospective Study.

Acute dacryocystitis is an uncommon but serious condition in infants and needs immediate treatment. Although, medical management with systemic antibiotics remains the mainstay of initial treatment, there are recent studies justifying simultaneous Naso Lacrimal Duct (NLD) probing with acceptable success rate. To assess the success rate of probing in the management of infantile acute dacryocystitis and to analyse the factors affecting it. A prospective interventional study was designed and infants presenting with acute dacryocystitis with or without complications like dacryocystopyocele/ lacrimal abscess/preseptal cellulitis at a Tertiary Eye Care Centre from May 2014 to April 2016 were enrolled. Demographic details and baseline clinical characteristics were noted. Intravenous antibiotics were started and probing under general anaesthesia was done. Follow up was done after one month. Success was defined as subsidence of acute attack and resolution of epiphora at final follow up of one month. A total 20 eyes of 18 patients were included with male: female ratio 10:8. Mean age of patients was 6.5 months and the mean duration of symptoms was 5.6 days. Dacryocystitis with lacrimal swelling was present in five eyes, preseptal cellulitis was present in two eyes while the rest 13 eyes presented with simple inflammation over the lacrimal sac. After one month, 85% (17eyes) had complete resolution of symptoms. Recurrence of epiphora was seen in 15% (three eyes) after initial improvement. Medical management with simultaneous probing of nasolacrimal duct has fairly good success rate in infantile dacryocystitis. Presence of dacryopyocele or dacryocystocele can lead to failure of probing owing to presence of intranasal cysts.

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

ObjectivesTo evaluate the long-term outcomes of cruciate marsupialization of intranasal cysts associated with congenital dacryocele. MethodsThis 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. ResultsThe 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%. ConclusionCruciate 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.

Congenital Heminasal Hypoplasia with an Intranasal Cyst and Its Management by Subnasal Rotation Flap

ABSTRACTVarious congenital nasal deformities can occur because of the complexities of the developmental process. These conditions range from partial deformities of the nose (such as isolated absence of the nasal bones, absence of columella, absence of the septal cartilage, and absence of vomeral bone) to complete absence of the nose. Congenital heminasal hypoplasia is an extremely rare defect of embryogenesis. We present a case of 25-year-old lady with congenital heminasal hypoplasia associated with intranasal cyst. Computed tomography (CT) scan revealed gross septal deviation to left, rudiment left lateral wall of the nose, rudiment left external nasal framework, and intranasal cyst. Functional septorhinoplasty was done with subnasal rotation flap technique to gain airway on both sides of the nose.How to cite this articleDevasamudra CR, Sagar NJ, Jayaraju RM. Congenital Heminasal Hypoplasia with an Intranasal Cyst and Its Management by Subnasal Rotation Flap. Int J Otorhinolaryngol Clin 2016;8(2):56-59.

Congenital dacryocele with large intranasal cyst: efficacy of cruciate marsupialization, adjunctive procedures, and outcomes.

To evaluate the safety and efficacy of a new technique of medial wall cruciate marsupialization of large intranasal cysts associated with dacryocele and to evaluate the outcomes. A prospective, interventional consecutive case series of 7 patients with large intranasal cysts were included in this study. All patients underwent endoscopic marsupialization by a single surgeon (MJA) using a new technique involving a medial wall cruciate incision. Patients were followed up for a minimum of 6 months and analyzed for the resolution of dacryocele and intranasal cysts and anatomical and functional success. The mean age at presentation was 5.9 weeks with a female preponderance (71.4%). All patients presented with a subcutaneous swelling in lacrimal sac region. Acute dacryocystitis was noted in 42.8% (3/7). Associated lacrimal anomalies were noted in 28.5% (2/7), and associated respiratory distress was noted in 57.1% (4/7) of the patients. At a mean follow up of 10.8 months, anatomical patency and resolution of intranasal cyst were achieved in all cases, and functional success was noted in all except 1 patient. Endoscopic evaluation of all dacryoceles is recommended. Medial wall cruciate marsupialization is a safe and effective modality in the management of large intranasal cysts. Early diagnosis and appropriate quick referral are likely to prevent acute dacryocystitis, progression of dacryocele, and may aid in better outcomes.

Congenital dacryocystocele: presentation and treatment

To report the presentation, complications, and treatment strategies for infants with congenital dacryocystocele. We performed a retrospective chart review of all patients presenting with dacryocystoceles to Beijing Children's Hospital between 2007 and 2011. Thirty-one patients (33 eyes) were identified, presenting at a median age of 10 days of life. Twenty-four (72.72%) patients presented with cellulitis or dacryocystitis and required systemic antibiotics. Two (6.45%) patients presented with respiratory compromise. Resolution occurred with conservative treatment for 6 eyes, but 27 (81.82%) required surgical intervention. All 27 eyes received probing, and 20 (74.07%) were successful. The other 7 eyes required marsupialization of an intranasal cyst. Although congenital dacryocystoceles may resolve with conservative measures, many become infected and require systemic antibiotic treatment, and most require surgical intervention. Referral in the early neonatal period can aid in timely intervention before complications such as infection occur.

A case of congenital heminasal hypoplasia with an intranasal cyst: An extremely rare occurrence

Various congenital nasal deformities can occur because of the complexities of the developmental process. These conditions range from partial deformities of the nose (such as isolated absence of the nasal bones, absence of columella, absence of the septal cartilage, and absence of vomeral bone) to complete absence of the nose. Congenital heminasal hypoplasia is an extremely rare defect of embryogenesis. We present a case of congenital heminasal hypoplasia with an associated dacryocystocele and intranasal cyst. The treatment of congenital dacryocystocele remains controversial. The majority of researchers recommend an initial treatment plan that does not include surgical intervention. Surgical reconstruction of the external nose and inner cavities can be delayed at least until the preschool years, when facial development is nearly complete.

Associated signs, demographic characteristics, and management of dacryocystocele in 64 infants

To describe the incidence of associated infection, respiratory compromise, apparent intranasal cyst, as well as sex, laterality, and age at presentation in 64 infants with dacryocystocele and to assess characteristics associated with successful interventions. A retrospective chart review of all patients with dacryocystocele seen at Children's Hospital Boston between 1996 and 2010 was performed. Inclusion criteria were accuracy of diagnosis, treatment, and follow-up at our institution. Interventions were divided into 3 categories: procedures that did not require general anesthesia; simple procedures requiring general anesthesia, such as nasolacrimal probing with or without stent or balloon dilation; and more complex procedures under general anesthesia, specifically, those aided by intranasal endoscopy. Of the 90 identified patients, 64 met inclusion criteria. The majority of patients were female (63%) and had unilateral involvement (77%). More than one-half of all patients were successfully treated without anesthesia; however, patients presenting with infection were more likely to be treated with a simple procedure under general anesthesia. All patients treated endoscopically had intranasal cysts. Age, sex, and infection did not predict the use of intranasal endoscopy. Bilaterality of dacryocystocele was associated with the use of an endoscopic approach. Many infants with dacryocystocoele can be successfully treated without general anesthesia. The incidence of occult intranasal cyst among those treated without endoscopy remains unknown. Patients who were treated under general anesthesia but without the use of nasal endoscopy were more likely to have an infected system, but the clinical significance of this association is not clear.