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J Neurol Surg B Skull Base
DOI: 10.1055/a-2627-3969
Original Article

Endoscopic Endonasal Dacryocystectomy for Tumors Involving the Nasolacrimal Duct and Lacrimal Sac

Lifeng Li    *
1   Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
,
Weiwei Wang   *
1   Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
2   Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Anhui Medical University, Anhui, People's Republic of China
,
Nyall R. London Jr.
3   Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
,
Tianhua Yi
4   Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Shaoyang University, Hunan, People's Republic of China
,
Yonggang Jin
5   Department of Otolaryngology-Head and Neck Surgery, Xianghe People's Hospital, Hebei, People's Republic of China
,
Xiahong Chen
1   Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
› Author Affiliations
Funding This study was supported by the Beijing Municipal Administration of Hospitals Incubating Program (PX2024008).
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Abstract

Purpose

Endoscopic endonasal dacryocystorhinostomy is performed to treat epiphora in patients with chronic dacryocystitis. However, the potential application of an endonasal dacryocystectomy for malignancies involving the lacrimal system (lacrimal sac and nasolacrimal duct) has not been sufficiently investigated. This study aims to assess the feasibility of an endonasal dacryocystectomy and to investigate its efficacy with clinical case scenarios.

Materials and Methods

An endoscopic endonasal dacryocystectomy was conducted on two cadaveric specimens (four sides). An endonasal dacryocystectomy for tumors involving the lacrimal system was performed in six patients. The feasibility of performing an endonasal dacryocystectomy was assessed on cadaveric dissection, and the efficacy of endonasal dacryocystectomy for patients with involvement of the lacrimal system was evaluated.

Results

Endonasal extirpation of the lacrimal system was feasible on four cadaveric sides. For five patients with sinonasal malignancies (two adenoid cystic carcinoma, one squamous cell carcinoma, two mucosal melanoma) and one with lacrimal sac melanoma, endonasal dacryocystectomy was successfully performed and negative margins achieved in all six patients. One patient harbored postoperative epiphora, no other comorbidities were detected. With an average follow-up of 18 months, no regional recurrence at the lacrimal system was detected.

Conclusion

To perform an endoscopic endonasal dacryocystectomy is feasible on cadaveric specimens. For sinonasal malignancies secondary involving the lacrimal system, it is possible to conduct an endonasal resection when the indication is appropriately selected.

Keywords

nasolacrimal duct - lacrimal sac - dacryocystectomy - endonasal - sinonasal malignancies

* Both these authors contributed equally to this manuscript.




Publication History

Received: 12 February 2025

Accepted: 03 June 2025

Article published online:
18 June 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • Reference

  • 1 Roithmann R, Burman T, Wormald PJ. Endoscopic dacryocystorhinostomy. Braz J Otorhinolaryngol 2012; 78 (06) 113-121
    PubMedSearch in Google Scholar
  • 2 Carifi M, Carifi G. Endoscopic endonasal dacryocystorhinostomy. J Craniofac Surg 2014; 25 (02) 717-718
    PubMedSearch in Google Scholar
  • 3 Jawad A, Kausar A, Iftikhar S, Akhtar N, Rabbani Z. Results of endoscopic endonasal dacryocystorhinostomy: a prospective cohort study. J Pak Med Assoc 2021; 71 (05) 1420-1423
    PubMedSearch in Google Scholar
  • 4 Ferrari M, Migliorati S, Tomasoni M. et al. Sinonasal cancer encroaching the orbit: ablation or preservation?. Oral Oncol 2021; 114: 105185
    PubMedSearch in Google Scholar
  • 5 Kuan EC, Wang EW, Adappa ND. et al. International consensus statement on allergy and rhinology: sinonasal tumors. Int Forum Allergy Rhinol 2024; 14 (02) 149-608
    PubMedSearch in Google Scholar
  • 6 Abdelmeguid AS, Raza SM, Su SY. et al. Endoscopic resection of sinonasal malignancies. Head Neck 2020; 42 (04) 645-652
    CrossrefPubMedSearch in Google Scholar
  • 7 Stavrakas M, Karkos PD, Tsinaslanidou Z, Constantinidis J. Endoscopic Denker's approach for the treatment of extensive sinonasal tumors: our experience. Laryngoscope 2021; 131 (07) 1458-1462
    PubMedSearch in Google Scholar
  • 8 McCormick JP, Suh JD, Wang EW. et al. Modified endoscopic Denker's approach for management of anterior maxillary sinus tumors: multicenter series of 58 cases. Am J Rhinol Allergy 2022; 36 (06) 763-772
    PubMedSearch in Google Scholar
  • 9 Li J, Wang J, Sun C. Early endonasal dacryocystorhinostomy for acute dacryocystitis: a systematic review and meta-analysis. Am J Rhinol Allergy 2024; 38 (03) 185-191
    PubMedSearch in Google Scholar
  • 10 Rawal RB, Farzal Z, Federspiel JJ, Sreenath SB, Thorp BD, Zanation AM. Endoscopic resection of sinonasal malignancy: a systematic review and meta-analysis. Otolaryngol Head Neck Surg 2016; 155 (03) 376-386
    CrossrefPubMedSearch in Google Scholar
  • 11 Li L, London Jr NR, Prevedello DM, Carrau RL. A novel landmark for endonasal surgery of the pterygopalatine fossa and inferior orbital fissure: the orbito-pterygo-sphenoidal ligament. Head Neck 2021; 43 (12) 4022-4029
    CrossrefPubMedSearch in Google Scholar
  • 12 Li L, London Jr NR, Prevedello DM, Carrau RL. Anatomical variants of the infraorbital canal: implications for the prelacrimal approach to the orbital floor. Am J Rhinol Allergy 2020; 34 (02) 176-182
    PubMedSearch in Google Scholar
  • 13 Li L, London Jr NR, Silva S, Prevedello D, Carrau RL. Transnasal prelacrimal approach to the inferior intraconal space: a feasibility study. Int Forum Allergy Rhinol 2019; 9 (09) 1063-1068
    PubMedSearch in Google Scholar
  • 14 Li L, London Jr NR, Prevedello DM, Carrau RL. Endoscopic endonasal approaches to the medial intraconal space: comparison of transethmoidal and prelacrimal corridors. Am J Rhinol Allergy 2020; 34 (06) 792-799
    PubMedSearch in Google Scholar
  • 15 Jawaheer L, MacEwen CJ, Anijeet D. Endonasal versus external dacryocystorhinostomy for nasolacrimal duct obstruction. Cochrane Database Syst Rev 2017; 2 (02) CD007097
    PubMedSearch in Google Scholar
  • 16 Tokat T, Tokat S, Kusbeci T. Long-term outcomes of transcanalicular laser dacryocystorhinostomy versus endonasal dacryocystorhinostomy and a review of the literature. Niger J Clin Pract 2023; 26 (08) 1069-1074
    PubMedSearch in Google Scholar
  • 17 Carlton DA, David Beahm D, Chiu AG. Sinonasal malignancies: endoscopic treatment outcomes. Laryngoscope Investig Otolaryngol 2019; 4 (02) 259-263
    CrossrefPubMedSearch in Google Scholar
  • 18 Castelnuovo P, Turri-Zanoni M, Battaglia P, Antognoni P, Bossi P, Locatelli D. Sinonasal malignancies of anterior skull base: histology-driven treatment strategies. Otolaryngol Clin North Am 2016; 49 (01) 183-200
    CrossrefPubMedSearch in Google Scholar
  • 19 Ferrari M, Orlandi E, Bossi P. Sinonasal cancers treatments: state of the art. Curr Opin Oncol 2021; 33 (03) 196-205
    PubMedSearch in Google Scholar
  • 20 Elsamna ST, Ahsanuddin S, Mir GS. et al. Surgical margin status and survival following resection of sinonasal mucosal melanoma. Laryngoscope 2021; 131 (11) 2429-2435
    CrossrefPubMedSearch in Google Scholar
  • 21 Lund VJ. Sinonasal malignant melanoma. Adv Otorhinolaryngol 2020; 84: 185-196
    CrossrefPubMedSearch in Google Scholar
  • 22 Salari B, Foreman RK, Emerick KS, Lawrence DP, Duncan LM. Sinonasal mucosal melanoma: an update and review of the literature. Am J Dermatopathol 2022; 44 (06) 424-432
    PubMedSearch in Google Scholar
  • 23 Castelnuovo P, Dallan I, Battaglia P, Bignami M. Endoscopic endonasal skull base surgery: past, present and future. Eur Arch Otorhinolaryngol 2010; 267 (05) 649-663
    CrossrefPubMedSearch in Google Scholar
  • 24 Snyderman C, Kassam A, Carrau R, Mintz A, Gardner P, Prevedello DM. Acquisition of surgical skills for endonasal skull base surgery: a training program. Laryngoscope 2007; 117 (04) 699-705
    CrossrefPubMedSearch in Google Scholar
  • 25 Kong KA, Thorp BD, Sheth SH. The role of induction therapy for sinonasal cancers. Curr Treat Options Oncol 2023; 24 (03) 162-169
    CrossrefPubMedSearch in Google Scholar