Case 3: An Abnormal Nose Mass.

Abstract

A term, small-for–gestational age (3rd percentile) Southeast Asian female infant is born at 39 1/7 weeks via uncomplicated, spontaneous vaginal delivery to a 36-year-old gravida 5, para 5 mother. The pregnancy is complicated by gestational hypothyroidism, which is treated with levothyroxine. Prenatal ultrasonography showed normal fetal anatomy at 20 weeks. At birth, her Apgar scores are 9 and 10 at 1 and 5 minutes, respectively. Examination reveals a healthy-appearing, small-for–gestational age female infant in no cardiopulmonary distress with the following facial deformities: 1) a 1-cm subcutaneous deep blue cystic soft tissue mass just medial to the medial canthus of the left eye; 2) soft tissue swelling of the nasal bridge; 3) mild right-sided deviation of the superior aspect of the nose with an anterior bony void between the nasal bone and nasal cartilage on palpation; and 4) bilateral upslanting palpebral fissures and hypertelorism (Fig 1). A well-lubricated 5-Fr feeding tube is easily passed through the left nare. The initial diagnosis is a large dacrocystocele with potential nasal bone fracture from birth trauma. No imaging is undertaken because the infant is in stable condition. She is discharged from the hospital with her mother on day 2 after birth. Figure 1. Left-sided nasal mass at birth. Around 2 weeks of age, she is evaluated by an otolaryngologist for an enlarging of the mass. Magnetic resonance imaging …