Neonatal respiratory distress secondary to bilateral intranasal dacryocystocoeles

A rare cause of intermittent respiratory distress and epiphora in the newborn: congenital dacryocystocele

“…Kim et al (14) presented cases of bilateral CDCs causing respiratory distress in the newborn. For patients with unilateral CDC and nasal extension, feeding difficulties, sleep disturbances and intermittent respiratory distress due to vascular congestion of the contralateral side during physiological nasal cycle can occur (8). Our case was a bilateral CDC with intranasal extension, but since the right side was affected minimally with a small intranasal cyst, respiratory distress occurred intermittently mostly during feeding and sleep.…”

“…Differential diagnosis of respiratory distress in the newborn is broad including congenital malformations such as choanal atresia, meningo-encephalocele, dermoid cyst, Thornwaldt cyst, pyriform aperture stenosis, tumoral lesions such as glioma, craniopharyngioma, and edema of the nasal mucosa (8). CDC with intranasal cyst, however, is typically not considered as a primary cause of respiratory distress in the newborn (4).…”

“…For the differential diagnosis of CDC with intranasal extension, other paranasal lesions such as nasal encephalocele, dermoid, hemangioma, nasal glioma, lymphangioma, heterotrophic brain must be considered in the differential diagnosis (5,6). To differentiate CDC with intranasal mucocele from meningocele or encephalocele clinically, it is possible to pass a nasal endoscope medial to a nasolacrimal duct cyst, which is not possible in case of a meningocele or encephalocele (8). Ultrasonography is an inexpensive and easily available imaging method for initial imaging method of CDC cases.…”

“…Generally, the main indications for surgical treatment of CDC cases are concomitant infection or respiratory distress due to bilateral nasal involvement and unresponsiveness to conservative treatment options (8). However, Mimura et al (7) presented the success of conservative management in the treatment of CDC cases even with intranasal involvement and dacryocystitis, they advised surgical treatment for only patients with respiratory distress.…”

“…Our case demonstrates the importance of surgical intervention for CDC cases showing both signs of infection and respiratory distress. In the contemporary surgical management of CDC cases with intranasal cyst, two main surgical options are present: marsupialization of the intranasal cyst with nasal endoscopy, and combined endoscopic marsupialization with probing (8). Blind probing is no longer advised, since it can fail to perforate the wall of the intranasal cyst, or restenosis in the perforation site can occur (5).…”