Objective:To investigate the effectiveness of nasal endoscopic anterior lacrimal recess approach combined with temporary fenestration of the nasal septum in resecting recurrent nasal inverted papilloma. Methods:Patients with recurrent nasal inverted papilloma who underwent reoperation in our hospital during the past 2 years were included . The nasal septum may hinder full access to and effective treatment of the lesions at the anterior and medial wall of the maxillary sinus by endoscope, aspirator and surgical instrument in the narrow aperture of the prelacrimal recess, although these lesions could be observed by 70° nasal endoscope. Results:The nasal septum is temporarily opened on the basis of the prelacrimal recess approach, and the nasal endoscope and instrument was introduced through trans-septal window, so as to provide a better view of the operative field and the angular range of the instrument's movement. Conclusion:The recurrent nasal inverted papilloma could be successfully managed by re-endoscopic anterior lacrimal recess approach combined with temporary fenestration of the nasal septum, and no recurrence was observed during the 2-year follow-up. This surgical approach is recommended for the inverted papilla which originates from the anterior medial wall of the maxillary sinus, as the tumor can be removed completely using this surgical approach.
Humans ; Papilloma, Inverted/pathology* ; Endoscopy ; Maxillary Sinus/pathology* ; Lacrimal Apparatus/surgery* ; Treatment Outcome ; Retrospective Studies

Objective: To describe the clinicopathologic features and outcome of a patient with epithelial-myoepithelial carcinoma of the lacrimal gland who underwent modified lateral orbitotomy with en toto removal of the lesion and adjuvant radiotherapy. Methods: This is a case report. Results: A 31-year-old Filipino male seafarer presented with a 2-month history of an enlarging left superotemporal orbital mass and inferonasal displacement of the globe. Magnetic resonance imaging revealed a superotemporal extraconal mass within the lacrimal sac fossa with evidence of osseous infiltration of the superolateral orbital rim. Modified lateral orbitotomy was performed with en toto removal of the lesion and the clinically infiltrated adjacent lateral bony margin. Histopathologic diagnosis of epithelial-myoepithelial carcinoma of the lacrimal gland was made based on the classic and distinct biphasic morphology and was confirmed with immunohistochemistry studies (cytokeratin-7, S-100, and p63). Systemic surveillance using positron emission tomography and computed tomography scan with contrast revealed no evidence of regional or distant metastasis. Adjuvant radiotherapy of the orbital area was performed for increased local control. Twelve months postoperatively, the patient showed no evidence of tumor recurrence. Conclusion Epithelial-myoepithelial carcinoma of the lacrimal gland is a rare condition, and this is the first documented case from the Philippines. Accurate diagnosis is necessary for appropriate treatment. It should be included in the differential diagnosis of infiltrative lesions in the lacrimal gland fossa.
Lacrimal Apparatus

Objective: To describe the cytopuncture microbiopsy (CM) technique performed during transcanalicular endoscopic lacrimal duct recanalization (TELDR) in patients with primary acquired nasolacrimal duct obstruction (PANDO) as an alternative to open biopsy, the standard method used in collecting specimen. Methods: This is a noncomparative, interventional case series with histopathologic correlation. Patients diagnosed with complete PANDO who underwent TELDR with balloon dacryoplasty and silicone intubation with CM at University of Santo Tomas Hospital from October 2014 to January 2017 were included. Results: Twenty (20) tissue specimens from the lacrimal sac and nasolacrimal duct were obtained from 18 patients. There were 16 females and 2 males included in the study. Mean age was 57.5 years. All specimens revealed few clusters of benign epithelial cells with few degenerated mononuclear cells and lymphocytes, and singly scattered lymphocytes that are set in fibrinous background. Tissue cytology studies were negative for malignant cells. Conclusion CM is a minimally invasive procedure that offers an alternative to open biopsy technique that can be done routinely during TELDR.
Dacryocystorhinostomy ; Lacrimal Apparatus Diseases

Humans ; Lacrimal Apparatus ; Endoscopy ; Carcinoma ; Eyelids

To investigate the values of orbital single photon emission computed tomography/computerized tomography (SPECT/CT) with 99mTc-diethylene triamine pentaacetic acid (99mTc-DTPA) on the evaluation of lacrimal gland inflammation in patients with thyroid associated ophthalmopathy (TAO).
 Methods: A total of 58 TAO patients were retrospectively recruited for this study, all of whom were categorized into all active group and all inactive group based on the clinical active score (CAS). Another 12 patients with the negative images on SPECT/CT served as a normal control group (NC). All patients were undergone the 99mTc-DTPA orbit SPECT/CT. Quantitative parameters of lacrimal gland including width, length, volume, and the count ratio of region of interest (ROI) drawn on lacrimal gland to the region of occipital brain (target/non-target ratio, T/NT), were measured on axial and coronal slices, respectively. Quantitative parameters were compared among the 3 groups, and the diagnostic value on discrimination of TAO patients from inactive to active ones was evaluated.
 Results: All parameters in TAO patients (except the length on coronal slices and the mean radioactive counts of axial T/NT in the TAO inactive group) were much greater than those in the NC group (P<0.05). All parameters in the TAO active group (except the length on axial and coronal slices) were much greater than those in the TAO inactive group (P<0.05). There were significant lineal positive correlations between the parameters in all TAO patients (except the length on coronal slices ) and CAS. The best diagnostic value was detected by the max radioactive counts of axial T/NT (area under the curve=0.82, P<0.01).
 Conclusion: As an invasive imaging modality, 99mTc-DTPA orbital SPECT/CT is helpful to estimate the lacrimal gland inflammation and to assess the disease activity in TAO patients.
Graves Ophthalmopathy ; Humans ; Inflammation ; Lacrimal Apparatus ; Orbit ; Retrospective Studies ; Tomography, Emission-Computed, Single-Photon ; Tomography, X-Ray Computed

Orbital tuberculosis is a rare form of extrapulmonary tuberculosis, even in endemic areas. It may involve the soft tissue, lacrimal gland, periosteum, or bones of the orbital wall. We present a case of orbital tuberculosis on the lower eyelid. An 18-year-old woman with no underlying disease visited our clinic for evaluation of an oval nodule (1.5× 1.2 cm) on the right lower eyelid. Incision and drainage without biopsy was performed 2 months ago in ophthalmology department, but the periorbital mass had deteriorated, as the patient had erythematous swelling, tenderness, and cervical lymphadenopathy. Visual acuity was normal; there were no signs of proptosis, diplopia, or ophthalmoplegia. Computed tomography revealed a small abscess cavity without bony involvement. We performed an excision and biopsy through a percutaneous incision under local anesthesia. Histological examination revealed a granuloma and was diagnosed as orbital tuberculosis. The patient was additionally treated with anti-tuberculosis therapy for 6 months and recovered without complication or recurrence by 7 months. Orbital tuberculosis occurs in patients with or without associated pulmonary tuberculosis, and should be considered as a differential diagnosis in patients with inflammatory orbital disease and an orbital mass. If recurrence occurs despite adequate initial treatment, we recommend an additional examination and excisional biopsy.
Abscess ; Adolescent ; Anesthesia, Local ; Biopsy ; Diagnosis, Differential ; Diplopia ; Drainage ; Exophthalmos ; Eyelids ; Female ; Granuloma ; Humans ; Lacrimal Apparatus ; Lymphatic Diseases ; Ophthalmology ; Ophthalmoplegia ; Orbit ; Orbital Diseases ; Periosteum ; Recurrence ; Tuberculosis ; Tuberculosis, Pulmonary ; Visual Acuity

The purpose of this study is to discuss several approaches to addressing naso-orbito-ethmoidal (NOE) fracture. Orbital fracture, especially infraorbital fracture, can be treated through the transconjunctival approach easily. However, in more severe cases, for example, fracture extending to the medial orbital wall or zygomatico-frontal suture line, only transconjunctival incision is insufficient to secure good surgical field. And, it also has risk of tearing the conjunctiva, which could injure the lacrimal duct. Also, in most complex types of facial fracture such as NOE fracture or panfacial fracture, destruction of the structure often occurs, for example, trap-door deformity; a fracture of orbital floor where the inferiorly displaced blowout facture recoils to its original position, or vertical folding deformity; fractured fragments are displaced under the other fragments, causing multiple-packed layers of bone.
Congenital Abnormalities ; Conjunctiva ; Fractures, Multiple ; Lacrimal Apparatus ; Maxillary Fractures ; Orbit ; Orbital Fractures ; Sutures ; Tears

Telecanthus is a common symptom accompanied by Waardenburg syndrome, a rare genetic disorder. The optimal surgery for telecanthus correction is still debated. A 28-year-old patient with Waardenburg syndrome underwent transnasal wiring canthopexy using a Y-V epicanthoplasty for telecanthus correction. A Mini-Monoka stent was used to prevent damage to the lacrimal apparatus. The intercanthal distance decreased from 50 mm to 43.2 mm. The easily designed Y-V epicanthoplasty incision provides sufficient operative field for oblique transnasal wiring, which is effective in properly positioning the medial canthal tendon. It has minimal scarring resulting in satisfactory cosmetic outcomes.
Adult ; Cicatrix ; Congenital Abnormalities ; Craniofacial Abnormalities ; Humans ; Lacrimal Apparatus ; Stents ; Tendons ; Waardenburg Syndrome

OBJECTIVES: Endoscopic prelacrimal medial maxillectomy (EPMM) was previously reported to treat maxillary inverted papilloma. This study aimed to compare prelacrimal recess approach with the conventional Caldwell-Luc approach (CLA) to remove benign maxillary sinus tumors and to evaluate the usefulness of this approach based on our experience. METHODS: Ten patients who underwent EPMM at our hospital from January 2013 to December 2017 were reviewed. We also reviewed 30 patients who underwent benign maxillary sinus tumor resection via CLA during the same period. From medical records, postoperative pathological results, complications due to surgery, and recurrence rate were evaluated. RESULTS: There were eight inverted papilloma, one ameloblastoma, and one ossifying fibroma in the EPMM group. In the CLA group, all 30 cases were inverted papilloma. There were no cases of failure at gross total removal during surgery, and no recurrences were observed during follow-up in either groups. Mean follow-up period was 13.0 months in CLA group and 10.8 months in EPMM group. Regarding postoperative complications, 11 patients of the CLA group (37%) and three patients of the EPMM group (30%) had numbness around the cheek and upper lip area after surgery (P=0.715). In the CLA group, there were eight patients who had numbness lasting more than 3 months after surgery, and two patients had numbness for more than 1 year. However, facial numbness disappeared within 3 months in all patients in the EPMM group, in which epiphora was not observed. CONCLUSION: EPMM is the effective surgical approach for resecting benign maxillary sinus tumor compared with CLA. Although facial numbness was reported in EPMM, the duration of numbness was shorter than CLA.
Ameloblastoma ; Cheek ; Endoscopy ; Fibroma, Ossifying ; Follow-Up Studies ; Humans ; Hypesthesia ; Lacrimal Apparatus Diseases ; Lip ; Maxillary Sinus Neoplasms ; Maxillary Sinus ; Medical Records ; Papilloma, Inverted ; Postoperative Complications ; Recurrence

PURPOSE: To describe the effects and long-term outcomes of incision and curettage treatment in patients with lacrimal gland ductulitis.METHODS: Twenty-four patients (24 eyes) with lacrimal gland ductulitis who were treated at Saevit Eye Hospital from June 2010 to November 2016. All patients underwent incision and curettage through the lacrimal ductule, and granules or concretions were removed. After the procedure, oral and topical antibiotics, oral anti-inflammatory agent were used for a week. Clinical presentations of the patients were analyzed. The resolution of symptoms and inflammatory signs and recurrence were evaluated more than 12 months after the procedure including telephone follow-up by a specialist nurse.RESULTS: Common symptoms were a painful, swelling mass with mucous discharge (17 eyes) and conjunctival injection (7 eyes) at the lateral canthal area. During the procedure, 22 patients (91.7%) had typical sulfur granule of Actinomyces, and 10 patients (41.7%) had many cilia in the expressed debris from the ductule. Twenty-three of 24 patients had resolution of symptoms after the procedure and all but one patient (95.8%) showed no recurrence.CONCLUSIONS: Incision and curettage is a simple and less invasive procedure that may be considered as a first treatment option for lacrimal gland ductulitis. Furthermore, incision and curettage of the affected lacrimal ductule has been shown to be effective at minimizing long-term recurrence of lacrimal ductulitis.
Actinomyces ; Anti-Bacterial Agents ; Cilia ; Curettage ; Follow-Up Studies ; Humans ; Lacrimal Apparatus ; Recurrence ; Specialization ; Sulfur ; Telephone