Secondary Logo

Journal Logo

OPRS Images

Nasal Trumpet Protects the Airway in Case of Bilateral Dacryocystoceles

Ocran, Cindy M.D.; Farivari, Nina M. M.D.; Sobel, Rachel K. M.D.; Padovani-Claudio, Dolly Ann M.D., Ph.D.

Author Information
Ophthalmic Plastic and Reconstructive Surgery: September/October 2020 - Volume 36 - Issue 5 - p e138
doi: 10.1097/IOP.0000000000001548
  • Free

In newborns, who are obligate nasal breathers, bilateral dacryocystoceles pose a risk of airway obstruction. Definitive management is endoscopic marsupialization of the cysts with intravenous antibiotics. Figure 1 illustrates a case of a 7-day-old boy who presented with bilateral mucopurulent discharge, medial canthal swelling, and erythema (Fig. 1A). CT revealed bilateral dacryocystoceles (Fig. 1B1, arrows) and intranasal cysts (Fig. 1B2, arrows) obstructing each nasal pathway with no evidence of encephalocele. Despite initial clinical response to intravenous antibiotics, the patient had notable increased work of breathing overnight. Emergent intervention was planned; however, the anesthesia team deferred an overnight procedure given patient’s age. As a stabilizing measure, a RUSCH (Teleflex, Morrisville, North Carolina, U.S.A.) 12 Fr nasal trumpet (Fig. 1C) was used to protect the airway. The appropriate size was determined by measuring the distance from the nasal ala to the angle of the mandible. The trumpet was lubricated with water-based jelly, inserted in the left nare, and pushed along the floor of the nasal cavity below and medial to the inferior turbinate to restore normal breathing (Fig. 1D, 1). Figure 1E illustrates potential cyst expansion (Fig. 1E, 2, black arrow) under the inferior turbinate causing obstruction (Fig. 1E, 2, left, red), and how the nasal trumpet (Fig. 1E, 2) maintains the airway (Fig. 1E, 2, right, green) despite cyst expansion (Fig. 1E, 3, black arrow). Intraoperatively, the right (Fig. 1F1, 2) and left (Fig. 1F1, 3) intranasal cysts were visualized and then marsupialized (Fig. 1F2). The patient was discharged at postoperative day 3 on oral antibiotics and tobramycin–dexamethasone drops and recovered successfully without further intervention.

FIG. 1.
FIG. 1.:
A nasal trumpet can successfully protect the airway to temporize management of bilateral dacryocystoceles. A, External photo of patient pre-procedure. B1/B2, Coronal CT of dacryocystoceles bilaterally. C, RUSCH Nasal trumpet. D, External photo with nasal trumpet in place. E, Diagram illustrating mechanism of airway maintenance with nasal trumpet. F, Endoscopic photos exemplifying dacryocystoceles prior to and after marsupialization.
© 2020 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.