Bilateral Nasolacrimal Duct Congenital Mucocele in a Newborn
by Rigante M1, Fiorita A1*, Libero R1, Savino G3,4, Cota F5,Vento G5,6,Galli J1,2
1Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario A. Gemelli Fondazione IRCCS, 00168 Rome, Italy
2Institute of Otolaryngology, Università Cattolica Sacro Cuore, 00168 Rome, Italy
3Ocular Oncology Unit, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
4Department of Head, Neck and Sense Organs, Catholic University of the Sacred Heart, Rome, Italy
5Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
6Neonatology Unit, Catholic University of the Sacred Heart, Rome, Italy
*Corresponding author: Antonella Fiorita, Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, 00168 Rome, Italy
Received Date: 02 April 2024
Accepted Date: 08 April 2024
Published Date: 10 April 2024
Citation: Rigante M, Fiorita A, Libero R, Savino G, Cota F, et al (2024) Bilateral Nasolacrimal Duct Congenital Mucocele in a Newborn. Ann Case Report. 9: 1752. https://doi.org/10.29011/2574-7754.101752
Abstract
A new-born at 38+0 weeks of gestational age presented with respiratory distress (resolved with oxygen administration) and swelling along the inner corner of the left eye with a deformed profile of the palpebral fissure in the medial canthal region. CT scan showed a hypo dense formation with fluid/suprafluid density, originating from the left nasolacrimal duct and extended caudally into the inferior nasal meatus and a smaller one, the right nasal inferior meatus. Histologic examination showed the lesion to be compatible with nasolacrimal mucoceles.
Keywords: Nasolacrimal Duct; Dacryocystocele; Dacryocystitis; Nasolacrimal Duct Obstruction Endoscopic Treatment
Introduction
A congenital mucocele of the nasolacrimal duct is an uncommon lesion that results from the mal-development of the nasolacrimal drainage system [1-5]. Complications of this condition can include epiphora, dacryocystitis, cellulitis, sepsis, and respiratory distress [2]. Computed tomography (CT) has been shown to play an essential role in diagnosing this entity [1].
Surgical treatment with marsupialisation of the mucocele in newborns is rarely described and prescribed in case of nasal obstruction that does not resolve spontaneously with conservative treatment.
Case Report
From a normal pregnancy, a female new-born born at 38+0 weeks of gestational age and birth weight 3295 grams by elective caesarean section to a second pregnancy 0 para mother (1 previous caesarean section), Apgar score 9-9, showed at 15 minutes of life respiratory distress requiring oxygen administration. For this reason, the new-born was admitted to the Neonatal Intensive Care Unit (NICU), where swelling was observed along the left internal medial canthus, which deformed the profile of the eyelids (Figure 1). During her stay in the NICU, the respiratory symptoms resolved rapidly (FiO2 of 0.25 for 24 hours), so after one day the new-born was re-united with her mother in the Rooming-In department: she was eupnoic with normal values of SpO2 (98%) and heart rate (120 bpm), good air penetration bilaterally in the thorax, abdomen not painful on superficial or deep palpation. Given the suspicion of mucocele of the lacrimal ducts at the ophthalmological examination, a conservative treatment was performed with massage of the external lacrimal sac, antibiotic eye drops and a CT scan was requested. The ENT physical examination showed a greyish cystic lesion in the left nasal cavity under the inferior turbinate that appeared cranially displaced. The new-born girl presented with a cystic-looking swelling in the left medial canthus region and in the upper eyelid (Figure 1). A small round cystic reddish lesion was observed in the inferior meatus below the inferior turbinate in the right nasal fossa. The use of endoscopy in the operating room allowed the exploration of both nasal passages to exclude a small dacryocystocele which supported the radiological examination carried out. A CT scan of the paranasal sinuses without contrast documented the presence of a hypo dense formation with fluid/suprafluid density, with a total axial diameter of approximately 22 mm, originating from the left nasolacrimal duct and extending caudally into the nasal meatus ipsilateral inferior in an hourglass shape. This lesion cranially appeared as a hypo dense mass localized in the left medial orbital canthus (widening of the lacrimal sac). This hypo dense formation was compatible in the first hypothesis with the mucocele of the left nasolacrimal duct. On the right side, another similar, smaller lesion was evident in the nasal meatus inferior (Figure 2). Given the non-resolution with conservative treatment after ten days and the high risk of systemic infection, the patient underwent surgical therapy to drain and marsupialize the dacryocele. Under general anaesthesia, a dacryocystocele with an external component and an endonasal component under the inferior turbinate was appreciated during endoscopic surgical procedures supported by the figure of the ophthalmologist for combined approach. After probing and cannulating the inferior lacrimal canaliculus, the external component was drained, and the cyst was marsupialized at the level of the inferior meatus until it was highlighted and freed the opening of the nasolacrimal duct. Also, the right nasal cavity was explored, and a cyst was seen at the level of the inferior meatus below the head of the inferior turbinate, which was marsupialized, resulting in the leakage of purulent material. The inferior lacrimal canaliculus was probed and cannulated, and the probe was observed at the level of the inferior meatus (Figure 3). Histologic examination of the nasal component bilaterally confirmed the wall of a normal structured lacrimal sac, normotypical with notes of fibrosis of the chorion; the finding was compatible with dacryocystocele. Ten days following surgery (Figure 4), the patient was doing well; there was complete resolution of abnormalities, there were no signs of dacryocystitis bilaterally, no pathological secretions were observed when squeezing the lacrimal caruncle, patent nasal passages, no stagnation of serum-mucous secretions in the nasal passages.
Figure 1: Pre-operative view of the 13 days old new-born.