2016 Volume 55 Issue 4 Pages 544-548
A congenital nasolacrimal duct cyst (CNDC) is generally formed due to nasolacrimal duct obstruction during fetal development. Nasolacrimal duct obstruction leads to cystic enlargement of the duct resulting in the formation of an intranasal mass on the inferior meatus. Depending on the site and size, CNDC causes varying degrees of respiratory impairment. We report a male neonate with CNDC. The CNDC was surgically resected using an intranasal endoscopic approach. He presented with respiratory impairment just after birth and was treated with continuous positive airway pressure. An intranasal mass was located on the left inferior meatus. Computed tomography and magnetic resonance imaging showed an enlarged lacrimal sac and a nasolacrimal duct with the mass on the inferior meatus. Because his respiratory impairment became progressively more severe, an intranasal endoscopic marsupialization was performed with a microdebrider to improve his obstructed nasal respiration. Under general anesthesia, direct visualization of the left nasal cavity was performed using a straight telescope with an outside diameter of 2.7mm.
Endoscopic observation and iodine injection excluded the presence of right nasolacrimal duct cysts. Before marsupialization, the patency of the nasolacrimal duct was confirmed by iodine injection into the lacrimal punctum. The procedure with the microdebrider was carefully performed to prevent injury to the surrounding tissue. Nasal packing to prevent bleeding was not necessary. Although his respiratory state was not fully restored postoperatively, his obstructed nasal respiration was relieved, and no instances of recurrence or complications were noted. Nasal endoscopic marsupialization with a microdebrider represents a safe and effective method for the treatment of CNDC.