Endoscopic Endonasal Resection of a Lacrimal Duct Oncocytoma

Oncocytomas are rare, benign epithelial cell tumors with a propensity for local invasion and malignant transformation. While the incidence of nasolacrimal duct obstruction caused by a lacrimal sac tumor is low, this diagnosis radically alters patient treatment. We report a case of an 87-year-old woman with persistent left epiphora despite two prior dacryocystorhinostomy (DCR) procedures. During the second DCR, she was noted to have fullness of the left medial canthus and pathologic tissue diagnosis demonstrated an oncocytoma. Subsequent imaging revealed a large, expansive, locally destructive mass in the lacrimal system extending into the left maxillary sinus. Surgical excision was completed using an endoscopic endonasal approach in combination with a transorbital incision to achieve gross total resection of this tumor. Historically, tumors involving the nasolacrimal duct have required a lateral rhinotomy incision and open resection. Endoscopic approaches minimize facial scarring and postoperative morbidity leaving the patient with improved functional and cosmetic results. In this case, our patient requested a surgical approach that minimized facial scarring. Here, we present a novel approach of endoscopic resection of a nasolacrimal duct oncocytoma achieved with a multidisciplinary team of collaborating head and neck and oculoplastic surgeons.

No conflict of interest has been declared by the author(s).