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

Abstract

PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.