Surgical Management of Cysts and Papillomas of the Nose and Sinuses

Abstract

Nasal dermoid cysts, encephaloceles, and gliomas are thought to be developmentally related errors in the closure of the anterior neuropore through a persistent anterior cranial and dural defect. Dermoid cysts are the most common congenital midline nasal lesion and contain dermal appendages. Intracranial extension of dermoid cysts may be suggested by a bifid crista galli and enlargement of the foramen cecum on CT but should be confirmed with MRI. The ideal surgical approach for a dermoid cyst is debatable but should allow for repair of CSF leak and cribriform defects as well as acceptable scar formation and nasal reconstruction if necessary. Nasal gliomas are comprised of normal brain tissue that has persisted through an anterior cranial defect. Sinonasal encephaloceles can be further divided into nasofrontal, nasoethmoidal, and naso-orbital types depending on their site of herniation. A combined intracranial/extracranial approach is necessary to address an encephalocele, and this can be done as a single-staged procedure. Congenital nasolacrimal duct cysts can often be treated with conservative management, but respiratory distress or infection may require urgent probing and marsupialization.