Neonatal Nasal Obstruction: A Comprehensive Analysis of Our 20 Years' Experience.

Neonates are obligatory nasal breathers hence nasal obstruction is a very important symptom to be evaluated. Although causes can be trivial most of the time, they can be life-threatening in some. Respiratory distress immediately after birth, feeding difficulties, paradoxical cyanosis, and failure to thrive are the most evident symptoms, and determination of unilateral or bilateral involvement guides the rationale for elective or emergency intervention. This study aimed to evaluate the causes, presentation, and management of neonates with nasal obstruction. We collected the data of all the neonates evaluated for nasal obstruction at our hospital over the past 20 years from June 2003 to May 2023 and assessed the strategy of approach for diagnosis and management of those cases. In our study, the commonest cause for neonatal nasal obstruction was found to be choanal atresia and the rarest was iatrogenic. A variety of other causes were also reported. As neonatal nasal obstruction has a multitude of rare causes each carries a unique assessment and treatment plan. History taking and clinical examination are the most important parts of evaluation including endoscopic evaluation in an office-based setup. Imaging studies add to the evaluation of cases of anatomical obstructions and associated anomalies (syndromes). Early diagnosis and swift intervention can be life-saving. The need for follow-up visits and second-stage corrections should be emphasized in getting the best long-term results.

Lacrimal ductal cyst of the medial orbit: a case report.

BACKGROUND: The lacrimal ductal cyst (dacryops) is an uncommon clinical entity. It occurs anywhere that lacrimal gland tissue is present but most often appears as an expanding mass in the region of the lacrimal gland. The presence involving the medial part of the orbit is rare, ectopic location can be misleading in the differential diagnosis of orbital masses. The authors report a 53-year-old man who presented with dacryops occurred in an unusual location with significant clinical presentations. CASE PRESENTATION: A 53-year-old man had a painless mass located in the right superomedial orbit accompanied with foreign body sensation and lachrymation for two months, which had rapidly grown within 10 days. Decrease of visual acuity, high intraocular pressure (IOP) and limitation of extraocular movements in the right eye were present. The result of visual evoked potential (VEP) test suggested the impaired function of the optic nerve. Magnetic resonance imaging (MRI) studies revealed the presence of an isolated cystic lesion. The mass was completely removed via a transcutaneous approach, histopathologic findings were consistent with the lacrimal ductal cyst. The ocular motility and high IOP returned to normal. There had been no post-operative complications or signs of recurrence over five months follow-up. CONCLUSION: Lacrimal ductal cysts can present in the medial orbit, clinicians should include this entity in the differential diagnosis of orbital masses and be aware of its variable presentations such as high IOP in this case. We comment on the fact that many reported cases of ectopic dacryops may be an extension of normal lacrimal gland tissue.

Dacryops - A review.

Purpose: To review and summarize the epidemiology, clinical presentations, histopathologic characteristics and management of dacryops.Methods: A comprehensive PubMed, Embase and Google Scholar search of all articles written in English and non-English language articles with abstract translated to English on dacryops were reviewed. Data reviewed included epidemiology, etiology, pathogenesis, clinical presentations, histopathologic characteristics and management of dacryops.Results: Lacrimal ductal cysts or dacryops are classified based on locations: palpebral lobe cysts (simple dacryops); orbital lobe cysts; cysts of the accessory lacrimal glands of Krause and Wolfring; and cysts of ectopic (choristomatous) lacrimal glands. The exact etiology of dacryops remains unknown. Dacryops is usually asymptomatic but can present with varied symptoms depending on the type and associated complications. While complete excision of dacryops is generally recommended, marsupialization is also a safe and effective method for the treatment of dacryops in the palpebral lobe of lacrimal gland. Complete surgical excision via orbitotomy is required for deep orbital lesions.Conclusion: Dacryops is an uncommon benign cystic lacrimal gland tissue neoplasm. Dacryops can be classified into four types based on locations. Lesions could be either superficial that can be seen through the fornix or deep into the orbit. Observation is also an option for small or asymptomatic lesions. Surgery remains the mainstay of treatment for symptomatic cases, but approaches are different depending on the location of the lesions.

Clinical Characteristic of Lacrimal Ductal Cyst

PURPOSE: Through 13 cases of lacrimal ductal cysts which were diagnosed by clinical or histopathological findings, we investigated the clinical characteristic and the effect of cyst excision on lacrimal secretion. METHODS: As a primary treatment, cyst excisions(6 cases), marsupialzations(4 cases), and needle aspirations(3 cases) were performed and their results were compared. Pre-and postoperative lacrimal secretion tests(Schirmer I & BST) were performed on 10 cases which underwent cyst excision either primarily or secondarily(due to recurrences). A biochemical analysis of cyst fluid and serum IgA level was also done on 7 cases. RESULT: There were no recurrences on 6 surgically excised cases, but 1 out of 4 cases with marsupia-lizations and all 3 cases with needle aspirations recurred and underwent cyst excisions secondarily. Two out of 10 surgically excised cases showed reduced value of postoperative lacrimal secretion tests. Cyst fluid IgA levels were higher than that of serum in all 7 cases. CONCLUSION: The higher cyst IgA level may signify the presence of an active secretory precess within cyst walls. A complete cyst excision seems to be the best treatment choice for the prevention of recurren-ces and marsupialization is also considered as an alternative treatment modality. The cyst excision itself does not seem to affect lacrimal secretion.

A Case of Laryngeal Ductal Cyst Who has History of Endotracheal Intubation / 소아알레르기및호흡기학회지

Laryngeal cysts can be classified into saccular (24%) or ductal (75%) cysts. In infants who have undergone intubation, ductal cysts are occasionally seen in the subglottic region. These cysts are caused by irritation and obstruction of mucous gland ducts. A 20-month-old infant admitted to our department due to inspiratory stridor, wheezing, and dyspnea. She was born prematurely and had a past history of endotracheal intubation with ventilator of 9 days because of respiratory distress syndrome. At 31 days of age, she was intubated again for 5 days because of pneumonia. She had admitted our hospital repeatedly at 7, 8, 16, and 17 months because of inspiratory stridor, wheezing, cough and dyspnea and she was diagnosed as asthmatic bronchitis. But symptoms developed again, she readmitted. A lateral X-ray film of the neck and neck spiral CT revealed a 6x5 mm sized homogeneous mass in the posterior wall of the subglottic region causing airway obstruction. A laryngoscopy was performed and showed a 4x5 mm sized cystic mass in the subglottic region. Endoscopic resection was done by Nd : Yag laser. The postoperative course was satisfactory. Histologic examination showed a ductal cyst, lined with ciliated cuboidal epithelium. This subglottic ductal cyst was believed to be a late complication of endotracheal intubation.

A Case of Lacrimal Gland Duct Cyst Associated with Ptosis

The lacrimal gland ductal cyst is rare, and a closed cyst of the palpebral lobe of the lacrimal gland developing incidiously in the superotemporal cul-de-sac. The authors experienced a case of lacrimal gland ductal cyst, which was a relatively large-sized mass, protruding from the superior temporal conjunctival cul-de-sac. The patient showed temporal blepharoptosis with S-shape of lid margin, but she had no diplopia and limitation of extraocular muscles. The cystic lesion was excised completely through conjunctival approach and lateral canthotomy. Total resection is optimal technique to prevent recurrence. Histopathologically, the cyst contained serous contents in its cavity and its wall was lined by two layers of squamous epithelium, containing some lacrimal gland tissues. This cyst seems to be originated from the palpebral lobe of the lacrimal gland, considering its anatomical location and histopathological findings.