Congenital dacryocystocele associated with intranasal cysts: diagnosis and management.
OBJECTIVE
To improve the diagnostic and therapeutic database for congenital dacryocystoceles.


METHODS
Retrospective case study of 10 patients with dacryocystoceles treated in an academic integrated tertiary care practice. Management and outcomes are compared to previous reports in the literature.


RESULTS
Between the years 1990 and 2001, 10 patients were diagnosed with dacryocystoceles. Seven were females, and 3 were males. Age ranged from 1 to 75 days. Nine of 10 had a unilateral dacryocystocele, and 1 had bilateral dacryocystoceles. Epiphora was reported in 8 patients. Preoperatively, dacryocystitis, facial cellulitis, or both were present/developed in 2 patients. Symptoms of airway obstruction were present in 3 neonates. Surgery was performed in 9 of 10 patients and was a combined ophthalmology/otolaryngology surgery in 7 cases. Two patients were treated with probing only. Intranasal cysts were identified in all 7 patients who underwent a combined approach. Three of 7 patients had bilateral intranasal cysts. Follow-up ranged from 9 months to 10 years (mean, 5 years). Complete resolution was observed in 9 patients. One patient had postoperative nasolacrimal duct obstruction 2 months postoperatively, presenting with mucopurulent drainage and cellulitis. The existing literature often suggests conservative management as a treatment option.


CONCLUSIONS
True dacryocystoceles are a relative rarity. The literature describes a variable natural course of these lesions with resultant controversy in their management. The current results demonstrate successful treatment in 6 of 7 patients with an early combined surgical approach and 2 of 2 patients treated by probing alone. The high failure rate with conservative management, reported in the literature, supports early surgical intervention.
Shashy
Ronald G
RG
Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA.
Durairaj
Vikram D
VD
Durairaj
Vikram
V
Holmes
Jonathan M
JM
Hohberger
George G
GG
Thompson
Dana M
DM
Kasperbauer
Jan L
JL
D003560:Cysts / Q000150:complications / Q000151:congenital* / Q000175:diagnosis / Q000601:surgery*; D003608:Dacryocystorhinostomy / Q000379:methods; D004724:Endoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007767:Lacrimal Duct Obstruction / Q000150:complications / Q000151:congenital* / Q000175:diagnosis; D008297:Male; D009301:Nasolacrimal Duct / Q000002:abnormalities* / Q000601:surgery; D009668:Nose Diseases / Q000150:complications / Q000151:congenital* / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome