Respiratory distress in the newborn: congenital dacryocystocele without medial canthal mass

Nasal obstruction in the newborn is an important otolaryngological emergency since the newborns are obligatory nasal breathers. Congenital dacryocystoceles (CDC) causing respiratory distress in the newborn are rarely published, and most of the cases have the diagnostic sign of bluish medial canthal mass. When the CDC does not have a medial canthal mass, the diagnosis can be omitted, and a meticulous nasal flexible endoscopic examination is needed to confirm the diagnosis. Bilateral CDCs without medial canthal mass causing respiratory distress in the newborn are very rarely published. In this case report, we presented a 20 days old infant having respiratory distress due to bilateral CDC with intranasal cysts and without medial canthal mass. The diagnosis was made by careful endoscopic nasal examination with observing the inferior meatal cyst and remarking the inferior turbinate. Choanal atresia was also excluded by endoscopic examination. Imaging methods were not performed. The patient was treated with bilateral endoscopic marsupialization of the cyst and nasolacrimal probing. We discussed the importance of flexible endoscopic examination not to omit this rare entity and emphasized that imaging methods are not crucial for the diagnosis of CDC when the clinician can notice the inferior meatal cyst and exclude choanal atresia with the endoscopic examination.