Intranasal cyst marsupialization under otoscopy for congenital dacryocystocele

Abstract

Abstract Aim We present a new, simple intranasal cyst marsupialization (ICM) technique for congenital dacryocystocele (CDC). In this procedure, the otoscope and myringotome are used to perform ICM in the manner of otoscopic myringotomy. This method allows minimally invasive surgery as an office procedure without the need for general anesthesia or a nasal endoscope. Design: Prospective observational study Materials and Methods Twenty consecutive infants with 25 CDCs administrated at our facility from 2011 to July 2023 were enrolled. Five infants with 5 CDCs required surgical interventions due to resistance to conservative treatment. Among them, we evaluated the surgical method and the outcomes of 3 infants with 3 CDCs who underwent ICM in the manner of otoscopic myringotomy. Results Of the total 25 CDCs, 20 (80%) spontaneously resolved with conservative treatment. Surgical intervention was conducted on five infants with 5 CDCs. The median age at surgery was 97 days with interquartile range 6–164.5 days. Surgical procedures involved one of the following methods. (1) Probing by an ophthalmologist (2 infants with 2 CDCs), (2) ICM in the inferior meatus with a myringotome and alligator forceps under otoscopy by an otolaryngologist (3 infants with 3 CDCs). All cases were treated under topical anesthesia in the office setting, with successful outcomes by a single surgical procedure. Conclusion CDC was successfully treated by ICM in the manner of otoscopic myringotomy. Treatment of CDC using an otoscope and myringotome is a minimally invasive surgical procedure that can be performed in the office setting without the need for general anesthesia or advanced medical equipment such as a nasal endoscope. Moreover, the risk of false passage formation and/or recurrence due to probing can be avoided. We, therefore, propose this procedure as one of the practical ICM techniques for CDC.