PMC7593324_01
Flexible endonasal fiberscopic findings of the left nasal cavity. Hypertrophy of the left inferior turbinate was present, and the left inferior nasal meatus had disappeared (white arrowheads).
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F1
In addition, the anterior part of the left inferior nasal meatus had disappeared because the lateral portion of the inferior turbinate was adhering to the lateral wall of the inferior meatus (Figure 1).
Computed tomography (CT) findings. (A) Coronal view: the left nasolacrimal duct was enlarged from the lacrimal sac to the orifice (white arrowhead). (B) Axial view: the left nasolacrimal orifice was enlarged (white arrow).
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F2
CT scan showed the nasolacrimal orifice to be covered by soft tissue of the inferior turbinate (Figure 2B). Coronal CT-dacrocystography (CT-DCG) also showed enlargement of the left lacrimal duct from the lacrimal sac to the nasolacrimal orifice (Figure 3A).
CT-dacrocystographic findings. (A) Coronal view: contrast medium was vertically located from the lacrimal sac to the orifice. (B) Sagittal view: contrast medium accumulated posteriorly from the lacrimal orifice.
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F3
CT scan showed the nasolacrimal orifice to be covered by soft tissue of the inferior turbinate (Figure 2B). Coronal CT-dacrocystography (CT-DCG) also showed enlargement of the left lacrimal duct from the lacrimal sac to the nasolacrimal orifice (Figure 3A). In addition, sagittal CT-DCG revealed that an accumulation of contrast medium was extending posteriorly from the nasolacrimal orifice (Figure 3B).
Intraoperative endoscopic findings of marsupialization of the cystic lesion to the inferior meatus. (A) Drainage of purulent discharge (X) from the cystic lesion between the inferior turbinate and the lateral wall of the inferior meatus. (B) Tip of the lacrimal probe indicates the nasolacrimal orifice (white arrowhead). (C) The vertical bone of the inferior turbinate was separated from the surrounding tissue. (D) Silastic lacrimal intubation tubes were retrieved endonasally from the nasolacrimal orifice.
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F4
At this time, purulent discharge could be drained from the cystic lesion (Figure 4A). The tip of the lacrimal passage endoscope indicated the location of the nasolacrimal orifice as shown in Figure 4B, suggesting that the nasolacrimal drainage system, consisting of the puncta of the eyelid, the canaliculi, the lacrimal sac and the lacrimal duct and orifice, were clearly patent. After removal of the deformed vertical bone of the inferior turbinate (Figure 4C), a microdebrider blade was used to remove hypertrophic submucosal tissue from the lateral aspect of the inferior turbinate, which helped the remaining mucosa to roll upon itself to cover all raw surfaces. To prevent restenosis, silastic lacrimal intubation tubes (LACRIFAST, Kaneka Medix Corporation, Osaka, Japan) were placed through the upper and lower puncta, retrieved endonasally from the nasolacrimal orifice (Figure 4D), and then were left in place for 3 months after the operation.
Post-operative findings 6 months after the operation. (A) Fiberscopic findings showed that the nasolacrimal orifice could be observed in the inferior meatus (white arrow). (B,C) Coronal CT scan findings showed the inferior meatus and patency of the nasolacrimal duct and orifice.
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F5
By 6 months after the operation, repeat flexible endonasal fiberscopy showed preservation of the left inferior meatus and patency of the left nasolacrimal orifice (Figure 5A). In addition, a coronal CT scan showed that the nasolacrimal duct was widely patent (Figures 5B,C).