Ali Mohammad Javed, Psaltis Alkis James, Brunworth Joe, Naik Milind N, Wormald Peter-John
*Dacryology Service, L.V. Prasad Eye Institute, Hyderabad, India; and †Department of Otolaryngology Head and Neck Surgery, The Queen Elizabeth Hospital, Adelaide, Australia.
Ophthalmic Plast Reconstr Surg. 2014 Jul-Aug;30(4):346-51. doi: 10.1097/IOP.0000000000000206.
To evaluate the safety and efficacy of a new technique of medial wall cruciate marsupialization of large intranasal cysts associated with dacryocele and to evaluate the outcomes.
A prospective, interventional consecutive case series of 7 patients with large intranasal cysts were included in this study. All patients underwent endoscopic marsupialization by a single surgeon (MJA) using a new technique involving a medial wall cruciate incision. Patients were followed up for a minimum of 6 months and analyzed for the resolution of dacryocele and intranasal cysts and anatomical and functional success.
The mean age at presentation was 5.9 weeks with a female preponderance (71.4%). All patients presented with a subcutaneous swelling in lacrimal sac region. Acute dacryocystitis was noted in 42.8% (3/7). Associated lacrimal anomalies were noted in 28.5% (2/7), and associated respiratory distress was noted in 57.1% (4/7) of the patients. At a mean follow up of 10.8 months, anatomical patency and resolution of intranasal cyst were achieved in all cases, and functional success was noted in all except 1 patient.
Endoscopic evaluation of all dacryoceles is recommended. Medial wall cruciate marsupialization is a safe and effective modality in the management of large intranasal cysts. Early diagnosis and appropriate quick referral are likely to prevent acute dacryocystitis, progression of dacryocele, and may aid in better outcomes.
评估一种用于治疗与泪囊膨出相关的大型鼻内囊肿的内侧壁十字形袋形缝合新技术的安全性和有效性，并评估其治疗效果。
本研究纳入了7例大型鼻内囊肿患者的前瞻性、介入性连续病例系列。所有患者均由同一位外科医生（MJA）采用一种涉及内侧壁十字形切口的新技术进行内镜下袋形缝合术。对患者进行至少6个月的随访，并分析泪囊膨出和鼻内囊肿的消退情况以及解剖学和功能学上的成功情况。
就诊时的平均年龄为5.9周，女性占优势（71.4%）。所有患者均在泪囊区出现皮下肿胀。42.8%（3/7）的患者出现急性泪囊炎。28.5%（2/7）的患者存在相关的泪道异常，57.1%（4/7）的患者存在相关的呼吸窘迫。平均随访10.8个月时，所有病例均实现了解剖学通畅和鼻内囊肿消退，除1例患者外，所有患者均取得了功能学上的成功。
建议对所有泪囊膨出进行内镜评估。内侧壁十字形袋形缝合术是治疗大型鼻内囊肿的一种安全有效的方法。早期诊断和适当的快速转诊可能有助于预防急性泪囊炎、泪囊膨出的进展，并可能有助于取得更好的治疗效果。
