(congenital nasal mucocele)
Rare (2% of the lacrymo-nasal imperforations of the child). Form of imperforation of the lacrimonasal duct leading to the formation of a mass limited, at its base, by the lacrimal meatus in the nasal cavity, under the lower turbinate. At CT scanner or MRI, there is a mass often divided into two pockets ("hourglass" picture): a canthal pocket (internal angle of the eye) and a nasal pocket, which can displace the lower turbinate toward the septum. Adilated lacrimal canal sometimes connects these two pockets.
There is a female predominance. The symptomatology, which appears in the first months of life, can be:
- ophthalmic: medial canthal mass of bluish appearance, tearing, conjunctivitis and dacryocystitis
- and/or respiratory: high obstructive dyspnea, occasionally intermittent; acute respiratory distress in case of bilateral form.
Differential diagnosis: choanal atresia, meningo-encephalocele, tumor.
Treatment: spontaneous evolution (opening of the cyst) is favorable in 80% of cases; otherwise, a marsupialization of thecyst should be performed.
Anesthetic implications:
upper airway obstruction; in case of little symptomatic unilateral form, unexpected difficulty when nasal intubation (obstruction, flow of fluid or pus appearing during intubation)
References:
- Fayet B, Racy E, Charrier J-B.
Pathologie néonatale du sac lacrymal.
J Fr Ophtalmol 2009 ; 32 :352-6.
- Braun J-J, Debry C, Donato L, Riehm S.
Kyste larcymonasal congénital : une entité radioclinique à ne pas méconnaître.
Arch Pédiatr 2016 ; 23 :192-6.
Updated: February 2019