International Journal of Pediatric Otorhinolaryngology Extra
Volume 3, Issue 2 , Pages 78-80, March 2008

Intranasal mucocele of the nasolacrimal duct—A cause of neonatal nasal obstruction

  • W. Raith

      Affiliations

    • Department of Paediatrics, University of Graz, Auenbruggerplatz 30, A-8036 Graz, Austria
    • Corresponding Author InformationCorresponding author. Tel.: +43 316 385 3830/3725; fax: +43 316 385 2678.
    • ,
  • F. Reiterer

      Affiliations

    • Department of Paediatrics, University of Graz, Auenbruggerplatz 30, A-8036 Graz, Austria
    • ,
  • G. Wolf

      Affiliations

    • Department of Otorhinolaryngology, University of Graz, Auenbruggerplatz 20, A-8036 Graz, Austria
    • ,
  • M. Riccabona

      Affiliations

    • Department of Radiology, University of Graz, Auenbruggerplatz 9, A-8036 Graz, Austria
    • ,
  • W. Mueller

      Affiliations

    • Department of Paediatrics, University of Graz, Auenbruggerplatz 30, A-8036 Graz, Austria
    • ,
  • B. Urlesberger

      Affiliations

    • Department of Paediatrics, University of Graz, Auenbruggerplatz 30, A-8036 Graz, Austria

Received 3 September 2007; received in revised form 14 November 2007; accepted 14 November 2007. published online 15 January 2008.

Article Outline

Summary 

After a spontaneous delivery, a healthy female newborn showed a cyanotic spell.

The medical inspection shows a healthy newborn, only the nose was difficult to probe with the smallest tube. This leads to the diagnosis nasal obstruction.

The nasal-endoscopy shows cystic malformations which restrict the inferior nasal meatus totally on both sides and the common nasal meatus on the right side [2].

With ultrasound and magnetic resonance imaging these malformations were identified as a mucocele caused by a blocked nasolacrimal duct. By a following nasal-endoscopy the blocked duct was resected. After that the baby could breathe without any symptoms of airway obstruction.

Keywords: Cyanotic spell, Nasal obstruction, Intranasal mucocele, Nasolacrimal duct, Newborn

 

Almost after a spontaneous delivery, a primary healthy female newborn with APGAR 9/10/10 developed mild symptoms of airway obstruction during breast-feeding. The baby nurse administered decongestant nose-drops and the baby could breathe and drink well.

After 1h, during sleeping the baby showed a cyanotic spell.

The outcome of the medical inspection by the paediatrician shows a healthy newborn, only the nose was difficult to probe with the smallest tube (charrier 4). No tear film abnormalities were seen. This leads to the diagnosis nasal obstruction [1].

The nasal-endoscopy shows cystic malformations which restrict the inferior nasal meatus totally on both sides and the common nasal meatus on the right side [2].

Picture 1 shows the view from the nasal-endoscopy.

  • View full-size image.
  • Picture 1. 

    Endoscopic view: A blocked nasolacrimal duct, on the right and the left side, which leads to airway obstruction and breathing symptoms in the first hours after birth.

To identify the cystic malformations, the baby was investigated by ultrasound and with magnetic resonance imaging [3]. This examination identified these malformations as a mucocele caused by a blocked nasolacrimal duct (Picture 2). By a following nasal-endoscopy the blocked duct was resected and epithelium of the nasolacrimal duct was approximated on the nasal epithelium.

  • View full-size image.
  • Picture 2. 

    Magnetic resonance imaging (sagittal and coronal plane): Intranasal mucocele of the right and the left side, caused by a blocked nasolacrimal duct, which restrict the inferior nasal meatus totally on both sides and the common nasal meatus on the right side.

After that the baby could breathe without any problems and without any symptoms of airway obstruction.

Nasolacrimal duct obstruction is a relatively rare clinical problem, but is common in children with trisomy 21 and CHARGE syndrome [4], [5]. Our patient is not afflicted with any symptoms, and is still healthy today [6].

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References 

  1. Brachlow A, Schwartz RH, Bahadori RS. Intranasal mucocele of the nasolacrimal duct: an important cause of neonatal nasal obstruction. Clin. Pediatr. (Phila.). 2004;43(June (5)):479–481
  2. Shashy RG, Durairaj VD, Holmes JM, Hohberger GG, Thompson DM, Kasperbauer JL. Congenital dacryocystocele associated with intranasal cysts: diagnosis and management. Laryngoscope. 2003;113(January (1)):37–40
  3. Calhoun JH. Problems of the lacrimal system in children. Pediatr. Clin. North Am. 1987;34(December (6)):1457–1465(Review)
  4. Gregg T, Lueder MD. Treatment of nasolacrimal duct obstruction in children with trisomy 21. J. AAPOS. 2000;4(August (4)):230–232
  5. Bowling BS, Chanda A. Superior lacrimal canalicular atresia and nasolacrimal duct obstruction in CHARGE association. J. Pediatr. Ophthalmol. Starbismus. 1994;31(September–October (5)):336–337
  6. Mazzara CA, Respler DS, Jahn AF. Neonatal respiratory distress: sequela of bilateral nasolacrimal duct obstruction. Int. J. Pediatr. Otorhinolaryngol. 1993;25(January (1–3)):209–216

PII: S1871-4048(07)00089-5

doi:10.1016/j.pedex.2007.11.001

International Journal of Pediatric Otorhinolaryngology Extra
Volume 3, Issue 2 , Pages 78-80, March 2008

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