1/2. A silastic sheet found during endoscopic transnasal dacryocystorhinostomy for acute dacryocystitis.PURPOSE: To report the case of a silastic sheet that was found during an endoscopic transnasal dacryocystorhinostomy for treatment of acute dacryocystitis with necrosis of the lacrimal sac. methods: A thirty-two year old male presented with painful swelling on the nasal side of his left lower lid two weeks prior to visiting this clinic. Fourteen years ago, the patient was involved in a traffic accident and underwent surgery to reconstruct the ethmoidal sinus. Lacrimal sac massage showed a regurgitation of a purulent discharge from the left lower punctum. Therefore, the patient was diagnosed with acute dacryocystitis and an endoscopic transnasal dacryocystostomy was performed the next day. RESULTS: The surgical finding showed severe necrosis around the lacrimal sac and a 20 x 15-mm sized silastic sheet was found crumpled within the purulent discharge. The sheet was removed, the lacrimal sac was irrigated with an antibiotic solution, and a silicone tube was intubated into the lacrimal pathway. After surgery, the painful swelling on the nasal side of left lower lid resolved gradually, and there were no symptomatic complications three months later. CONCLUSIONS: We report the first case where a silastic sheet applied during a facial reconstruction had migrated adjacent to the lacrimal sac resulting in severe inflammation.- - - - - - - - - - ranking = 1keywords = dacryocystitis (Clic here for more details about this article) |
2/2. Spectrum of pediatric dacryocystitis: medical and surgical management of 54 cases.BACKGROUND: dacryocystitis in infants and older children is a serious complication of congenital or acquired nasolacrimal duct obstruction. To define the modes of presentation and treatment strategies of this disorder better, we reviewed the clinical courses of 54 children treated for dacryocystitis at St Louis Children's Hospital. methods: Clinical, neuroradiologic, and laboratory data were collated for all cases of dacryocystitis treated from 1990 to 1995. Average follow up of the children in this consecutive series was 1.75 years (range, 4 months to 5 years). RESULTS: Of the 54 patients, 36 (67%) had chronic low-grade dacryocystitis, which was treated with nasolacrimal duct probing on an outpatient basis. The remaining 18 patients (33%) had acute dacryocystitis, which was treated with a combined medical/surgical strategy. Medical treatment consisted of hospital admission for administration of intravenous antibiotics followed by inpatient surgery, which varied according to the age of the patient and the clinical history: 1) Acute dacryocystitis in neonates was treated surgically by nasolacrimal duct probing and nasal endoscopy for excision of intranasal duct cyst; 2) Acute dacryocystitis with periorbital cellulitis was treated surgically by nasolacrimal duct probing; 3) Acute dacryocystitis due to facial trauma was treated surgically by dacryocystorhinostomy and stent placement; and 4) Acute dacryocystitis complicated by orbital abscess was treated by inferior orbitotomy for orbital abscess drainage, simultaneous nasolacrimal duct probing, and stent placement. CONCLUSION: dacryocystitis in the pediatric population may present in either chronic or acute forms. An effective and safe treatment for acute dacryocystitis is hospital admission, both for administering intravenous antibiotics and monitoring to rule out orbital cellulitis or abscess formation. Intravenous antibiotic therapy is followed within a day or two by surgery tailored to the clinical history. In the majority of both chronic and acute cases, nasolacrimal duct probing appears to be an effective treatment strategy.- - - - - - - - - - ranking = 2.1666666666667keywords = dacryocystitis (Clic here for more details about this article) |