Nasal glial heterotopia in a 5-month-old girl – a case report

We report a rare case of nasal glial heterotopia in an adult. After the surgery, frontal lobe cerebral hemorrhage developed. A 58-year-old man had unilateral nasal obstruction that progressed for one year. He had been treated for hypertension, chronic heart failure, and cerebral infarction with aspirin and warfarin. A computed tomography scan showed that the tumor occupied the right nasal cavity and the sinuses with small defect in the cribriform plate. The tumor was removed totally with endoscopy. After the operation, the patient developed convulsions and frontal lobe cerebral hemorrhage. The hemorrhage site was located near a defect in the cribriform plate. Nasal glial heterotopia is a rare developmental abnormality, particularly rare in adult. Only few cases were reported. We could not find any report of adult nasal glial heterotopias that developed cerebral hemorrhage as a complication of the surgery.

Functional septorhinoplasty is an effective treatment for nasal airway obstruction. Little distinction exists between bilaterally and unilaterally obstructed patients in literature. Our study evaluates outcomes in patients with unilateral nasal airway obstruction compared to those with bilateral nasal airway obstruction as measured by nasal obstruction symptom evaluation scores following functional septorhinoplasty. A total of 227 patients underwent functional septorhinoplasty for nasal airway obstruction. Patients were grouped into unilateral (n = 64) and bilateral (n = 163) nasal obstruction cohorts based on patient report and physician assessment. Nasal obstruction symptom evaluation (NOSE) scores were obtained pre-operatively and post-operatively at least 3 months following surgery. Patients with unilateral nasal obstruction had slightly less severe symptoms preoperatively than patients with bilateral obstruction. Average preoperative NOSE scores for patients with unilateral obstruction was 64 (SD = 19) and 72 (SD = 18) for patients with bilateral obstruction (P = .004). Postoperative NOSE scores following septorhinoplasty were significantly reduced for patients with both unilateral and bilateral nasal obstruction (postoperative NOSE scores unilateral: 17, SD = 16 ; bilateral: 23, SD = 21). There was no statistical significance in outcomes between patients with unilateral or bilateral nasal obstruction groups. Symptoms in patients with unilateral obstruction are similar but slightly less severe than patients with bilateral obstruction. Patients with unilateral and bilateral nasal obstruction experienced a similar degree of improvement in symptom following functional septorhinoplasty.

Nasal glial heterotopia in children: Two case reports and literature review

Aim of the study: The aim of this case report is to outline the difficulties associated with managing a child with nasal glial heterotopia. Developmental midline nasal mass, especially of neurogenic origin, poses a great challenge to managing surgeons. Nasal glial heterotopia is among benign congenital midline nasal tumours with aggressive features. Case report: Herein, we report the case of a 5-month-old infant who presented earlier, at 3 months old, with respiratory distress secondary to obstructive nasal mass. Result and discussion: Imaging and bedside flexible nasopharyngolaryngoscopy showed a localised nasal mass with no intracranial tumour. Following two combined endoscopic intraoral and transnasal tumours, the diagnosis of nasal glial heterotopia was made, and the patient is under surveillance. Conclusion: Multidisciplinary team discussion along with combined endoscopic transnasal and transoral approach ought to be considered in managing challenging congenital nasal tumours in children.

Nasal glial heterotopia: a clinicopathologic and immunophenotypic analysis of 10 cases with a review of the literature.

Nasal glial heterotopia is a rare congenital defect that is formed during embryological development. This lesion is part of a larger group of diseases, congenital midline nasal tumors, that occur with a frequency of once per 20,000-40,000 live births. Histologically, nasal glial heterotopia is a concentration of glial tissue which exhibits no malignant potential. We can differentiate three basic types of the disease based on the location of the lesion: 60% of nasal gliomas are extranasal, 30% are intranasal and only 10% combine extra- and intranasal components. Because of the rare occurrence correct diagnosis is quite difficult. We present a case of 2.5-month male who was admitted to the Department of Pediatric Otolaryngology for the diagnosis and treatment of a tumor deforming the bridge of his nose. Initial differential diagnosis included encephalocele, glial heterotopia (nasal glioma), angioma, nasal dorsal cyst, rhabdomyosarcoma, lacrimal duct cysts. We performed endoscopic examination, radiological imaging (CT, MRI) and histological assessment of lesion. The patient was diagnosed with nasal glial heterotopia (extra-and intranasal) based on diagnostic studies and clinical manifestation. The resection of the lesion was performed by means of dual access, external and endoscopic. The results of surgical treatment are satisfactory, control endoscopy showed no residual tumor presence.

The management of midline transcranial nasal dermoid sinus cysts

The uncommon, non-hereditary congenital abnormalities known as nasal glial heterotopias (NGH) are composed of heterotopic neuroglial tissue. Typically, NGH manifests in infancy, but occasionally it can also be seen in older children and adults. To rule out intracranial extension, magnetic resonance imaging (MRI) and computed tomography (CT) scans should be performed. Numerous cases have been documented where NGH was mistakenly identified as encephaloceles, teratomas, dermoid cysts, capillary haemangiomas, and even desmoids. A proper clinical, sonological, and even CT and MRI evaluation can lead to a near-final diagnosis; nonetheless, surgical excision and histological confirmation are the gold standards. We report a rare case of a firm, subcutaneous, non-tender, non-reducible midline 2 x 2 x 1 cm swelling with bluish-red skin near the root of the nose that was not affected by posture or pressure. Encephalocele, NGH, and dermoid were the differential diagnoses made based on the oedema found on CT and MRI scans. Histopathology provided a conclusive NGH diagnosis. The instance illustrates the significance of histology as the gold standard for NGH diagnosis.

Nasal glial heterotopia or congenital hemangioma? A case report.

Traitement de la stérilité et mélanome : question non résolue en 2016

SUMMARYNasal glial heterotopia (NGH) is a rare congenital, non-neoplastic displacement of cerebral tissue in extracranial sites. Together with a case report of NGH, we present the first systematic review of all published cases in order to summarise the relevant clinical findings and appropriate therapy, making the available evidence accessible to decision makers. A total of 72 original publications including 152 NGH cases were identified. The male:female ratio was 3:2. Most patients were children under 18 years (130 patients) and only 8% of cases were diagnosed in adults. The main clinical presentation forms were asymptomatic masses around the nasal root as well as nasal congestion. Magnetic resonance imaging was performed in 39% of patients, computed tomography in 22% of patients and a combination of both in 20% of patients. A diagnostic biopsy was performed in only 7 patients. All patients underwent surgical treatment and recurrence was reported in 14 patients within the first year of follow-up. In conclusion, NGH should be considered as a differential diagnosis of nasal masses in children. MRI is mandatory in order to exclude a connection to the central nervous system. Complete resection is curative treatment.

Introduction Nasal gliomas - or nasal glial heterotopias - are rare congenital malformations, which correspond to 5% of the congenital nasal masses. It is a mass composed of mature glial tissue that can be located outside, inside or near the nasal region, and may or may not be connected to the brain by a fibrous pedicle. This report addresses a case of nasal glioma that suffered recurrence after endoscopic treatment. Case Report A 1-year-old boy has, since birth, a mass inside the left nostril, which obstructs and widens the bridge of the nose. Upon physical examination, it is observed that the mass does not increase in size with crying and presents negative transluminescence and Furstenberg test. Upon being biopsied, the lesion reveals malignancy and the presence of inflammatory cells. MRI ruled out communication with intracranial structures. The endoscopic resection of the heterotopia removed a mass of 3,0 × 2,5 × 1,7 cm, whose histological and immunohistochemical analysis revealed glial pattern cell proliferation in the nasal mucosa. Conclusion Considering that nasal glial heterotopy is frequently present at birth, and that newborns breathe predominantly through this route, early diagnosis of the lesion is of great importance, as it can cause signs and symptoms of respiratory distress. In addition, it is worth noting that the early approach also prevents bone deformities.

Nasal glial heterotopia: a clinicopathologic study of 10 patients

Nasal glial heterotopia: Four case reports with a review of literature

The objective of this paper is to investigate the differences between unilateral and bilateral nasal obstruction with subjective symptomatology in nasal obstruction. This is a retrospective chart review of prospectively collected data of patients with nasal obstruction presenting to a facial plastic and reconstructive surgery clinic for evaluation and treatment. Patient demographics including age and gender were recorded along with nasal physical exam findings. These included internal valve narrowing (IVN), external valve narrowing, internal valve collapse, external valve collapse, and septal deviations (inferior and superior). Findings were reported for the left, the right, and both sides. Nasal valve and septal findings were recorded on 3- and 4-point Likert scales, respectively, for each side of the nose. A total of 1,646 patients were included in the study. On univariate analysis, a significant correlation was seen between Nasal Obstruction Symptom Evaluation (NOSE) scores and all individual exam findings (p < 0.001). On multiple linear regression, total, left, and right septal deviation (p < 0.001, p = 0.001, p = 0.007, respectively) and total, left, and right IVN (p < 0.001, p = 0.003, p < 0.001) were all predictive of an increased NOSE score. Patients with unilateral septal deviation or internal nasal valve narrowing have symptoms of nasal obstruction similar to those with bilateral nasal obstruction. Unilateral and bilateral septal deviation and internal nasal valve narrowing are predictive of having an increased NOSE score. Unilateral nasal obstruction should be recognized and treated as a cause for severe symptomatic nasal obstruction despite a normal contralateral nasal exam.