The Treatment of Neonatal and Infantile Dacryocystoceles and Dacryocystitis with the Microdebrider
Lama Khatib, MD; James A. Katowitz, MD; William R. Katowitz, MD
The Children’s Hospital of Philadelphia
Introduction: The use of the nasal microdebrider in treating nasal cysts associated with neonatal and infantile dacryocystoceles and dacryocystitis in a small series is described
Methods: This is a retrospective chart review of patients treated with a microdebrider over a 3-year period at a single institution. Subjects with a diagnosis of dacryocystocele or dacryocystitis with associated intranasal cysts within the first 5 months of life were included. Patient age, date of post-operative care, orbital imaging (when obtained), intra-operative findings and wound culture were recorded. The resolution of symptoms with a clear dye disappearance test was used to denote surgical success.
Results: 24 charts were identified. 7 subjects had dacryocystoceles (4 bilateral, 3 unilateral). All cases of dacryocystoceles had associated intranasal cysts. 17 subjects had dacryocystitis (2 bilateral, 15 unilateral). A total of 5 subjects were excluded (2 subjects lost to follow-up and 3 with dacryocystitis without intranasal cysts). A total of 29 intranasal cysts (in 19 subjects) were included in this study. The average age at the time of surgery was 1.64 months (range 1 day to 5 months) with an average follow-up of 7.94 months (range 1.1 to 33.8 months). All cysts were fully removed with a nasal microdebrider (2.9 tri-cut blade). The overall success rate was 96.5% (28/29 cysts treated). The one failure required a dacryocystorhinostomy.
Discussion: Neonatal and infantile dacryocystoceles and dacryocystitis are often associated with intranasal cysts found under the inferior turbinate. This can cause respiratory distress and require urgent surgical care. The nasal Microdebrider represents a surgical alternative to intranasal cyst marsupializationin in the treatment of nasal cysts associated with neonatal and infantile dacryocystoceles and dacryocystitis. It offers the advantage of speed, accuracy and the capacity for complete cyst wall removal with encouraging results in this small series.
Conclusion: The microdebrider is a safe and effective surgical device in the treatment of nasal cysts associated with neonatal and infantile dacryocystoceles and dacryocystitis.
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