Successful Endoscopic Dacryocystorhinostomy Following Olfactory Neuroblastoma Resection: Considerations in a Fully Communicating Nasal Cavity
Author: Ayaka Kizaki
Base Hospital / Institution: Oculofacial Clinic Kyoto
ePoster presentation
Abstract ID: 25-140
Purpose
Olfactory neuroblastoma (ONB) is a rare malignant tumour originating in the upper nasal cavity. Extensive surgical resection can lead to significant anatomical alterations. We present a case of nasolacrimal duct obstruction (NLDO) and chronic dacryocystitis secondary to ONB resection, focusing on the surgical challenges encountered during endoscopic dacryocystorhinostomy (DCR).
Methods
A 62-year-old female underwent combined transcranial-endonasal resection of a large ONB at a university hospital. Subsequently, she developed right-sided epiphora and recurrent dacryocystitis. Nasal endoscopy revealed complete absence of the nasal septum and turbinates, and computed tomography demonstrated partial maxillary bone loss beneath the lacrimal sac. Due to the lack of anatomical landmarks, a light probe was introduced through the canaliculus to transilluminate and accurately localise the lacrimal sac. Endoscopic DCR was performed in this fully communicating nasal cavity, requiring meticulous bipolar coagulation to achieve haemostasis prior to silicone tube placement, as conventional nasal packing proved ineffective.
Results
Despite the severely altered anatomy, the use of a transcanalicular light probe enabled accurate localisation of the lacrimal sac, facilitating precise rhinostomy creation. Careful intraoperative haemostasis with bipolar coagulation allowed for successful DCR completion without complications. Postoperatively, the patient recovered uneventfully, and her epiphora resolved completely.
Conclusion
Extensive ONB resection can result in a fully communicating nasal cavity, rendering conventional nasal packing ineffective. In the absence of standard anatomical landmarks, transcanalicular light guidance is useful for accurate localisation of the lacrimal sac. Surgeons must anticipate such anatomical changes and adjust intraoperative haemostatic techniques and postoperative management strategies accordingly. With appropriate modifications, endoscopic DCR remains a viable treatment option even after extensive skull base surgery.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Masahiro | Fujimoto | Oculofacial Clinic Kyoto |
| Tomoyuki | Kashima | Oculofacial Clinic Tokyo |
