Congenital Nasal Lesions Research Articles

Less Is More in Congenital and Pediatric Nasal Lesions.

Congenital and pediatric nasal lesion resection and their reconstructive outcomes are not well studied. A surgeon must consider the site, size, depth, etiology, age, and effect on future function (including growth). As such, it is important to contrast the differences between the adult's and child's nose. The authors propose that more conservative resection and reconstructive methods may better serve congenital and pediatric nasal lesions. An Internal Review Board approved study of congenital and pediatric nasal lesions using a defect only approach from 2005 to 2017 was performed. Lesions, type of surgeries, complications, aesthetic outcome, and additional interventions were reviewed. One hundred twenty-seven patients met the study criteria with a median age at surgery of 5.4 years with follow-up of 1.4 years (1 week-11.3 years). The most common diagnosis was congenital melanocytic nevus (47, 37%). The lesions were located on more than 1 subunit in 34 (27%) patients with an average surface area of 3.7 (0.04-32) cm. The most common primary procedure was excision and primary closure with adjacent tissue undermining/rearrangement (73, 57.4%) followed by full-thickness skin graft (23, 18.1%). The aesthetic outcome was considered acceptable in a high number of patients 117 (92%), while 10 (8%) patients had unacceptable aesthetic outcomes, mostly due to scarring. The authors' data supports the concept of minimal healthy tissue excision or lesion only excision when treating pediatric and congenital nasal lesions.

Management of Nasal Dermoid Sinus Cyst by Modified Bipedicle Advancement Flap Technique

ABSTRACT Midline congenital nasal lesions are rarely encountered in adults. Nasal dermoid sinus cysts (NDSC) account for 1 to 3% of dermoid cysts overall and 11 to 12% of head and neck dermoids. Most lesions are diagnosed within the first 3 years of life but in some cases the diagnosis can be delayed. Nasal dermoid sinus cysts are unsightly, prone to infection. Treatment is complete surgical excision. We are presenting a case of 21-year-old man with a NDSC who presented with soft tissue hump over the bony nasal dorsum, recurrent infection and discharge from the two sinus openings over the bony nasal dorsum. We review the embryology of nasal dermoid sinus cysts, discuss their presentation, evaluation and management in adults. Radiological investigations like computed tomography (CT) scan, magnetic resonance imaging (MRI) are essential to know the extension of the sinus tract and CNS involvement. Complete surgical excision and reconstruction of the defect over the bony nasal dorsum by modified bipedicle advancement flap technique will help to give esthetically good looking nose. Abbreviations CNS: Central nervous system, CT: Computed tomography, MRI: Magnetic resonant imaging, NDSC: Nasal dermoid sinus cyst, PNS: Para nasal sinus. How to cite this article Devasamudra CR, Sagar NJ. Management of Nasal Dermoid Sinus Cyst by Modified Bipedicle Advancement Flap Technique. Clin Rhinol An Int J 2015;8(3):115-120.

CT and MRI of congenital nasal lesions in syndromic conditions.

Congenital malformations of the nose can be associated with a variety of syndromes, including solitary median maxillary central incisor syndrome, CHARGE syndrome, Bosma syndrome, median cleft face syndrome, PHACES association, Bartsocas-Papas syndrome, Binder syndrome, duplication of the pituitary gland-plus syndrome and syndromic craniosynsotosis (e.g., Apert and Crouzon syndromes) among other craniofacial syndromes. Imaging with CT and MRI plays an important role in characterizing the nasal anomalies as well as the associated brain and cerebrovascular lesions, which can be explained by the intimate developmental relationship between the face and intracranial structures, as well as certain gene mutations. These conditions have characteristic imaging findings, which are reviewed in this article.

Diagnostic imaging features of congenital nose and nasal cavity lesions.

A wide variety of congenital nasal lesions can present to clinical attention due to airway obstruction, the presence of a mass, and/or cosmetic deformity, including pyriform aperture stenosis, choanal atresia, nasopharyngeal atresia, arrhinia, congenital germline fusion cysts, cephaloceles, neuroglial heterotopia, nasolacrimal duct mucoceles, hamartomas, supernumerary nostril, and bifid nose. Computed tomography and magnetic resonance imaging, which are the main imaging modalities used to characterize these lesions, often serve complementary roles. Familiarity with embryology and anatomy is also essential for recognizing the diagnostic imaging findings related to congenital nasal lesions.

The external rhinoplasty approach for congenital nasal lesions in children

Objective Congenital lesions of the nose can be challenging to excise. While some lesions carry infection risks, in most cases surgery is primarily performed for cosmesis. Some lesions may extend up to the skull base and this can occasionally be missed on MRI scans. Surgical access has to allow complete excision in all circumstances, but access must be balanced against cosmetic results. We present our experience of the external rhinoplasty approach which allows wide access with little visible scarring. Methods Retrospective chart review of all cases performed between November 2003 and October 2009. Results 15 children underwent excisional surgery using the external rhinoplasty approach. They were aged 1–5 years at the time of surgery, and 12 were male. Pathology comprised congenital midline nasal dermoid cysts in 13 (of which 4 extended intracranially), extranasal glioma in 1 and non-resolving haemangioma in 1. The surgical approach provided adequate visualisation in all cases. The children with intracranial dermoids had resection and repair of the dura as part of their procedure. No post-operative CSF leaks occurred. One child with nasal dermoid had a small cyst recurrence in the skin of the nasal tip requiring further surgery but no deep recurrences occurred. Follow up ranges from 3 months to 6 years. Children with widened nasal bones before surgery have all shown rapid bony remodelling after surgery. Conclusions The external rhinoplasty approach offers excellent access in young children, even for intracranial lesions.

Adult Nasal Dermoid Sinus Cyst

Midline congenital nasal lesions are rarely encountered in adults. We present the case of a 31-year-old man with a nasal dermoid sinus cyst who presented with a nasal dorsal abscess. We review the embryology of nasal dermoid sinus cysts, and we discuss their presentation, evaluation, and management in adults.

Transglabellar Subcranial Approach for the Management of Nasal Masses With Intracranial Extension in Pediatric Patients

To describe the use of the transglabellar subcranial approach for the management of congenital nasal masses in the pediatric population. Case series. Medical records of 5 patients who underwent resection of congenital nasal lesions via the subcranial approach were reviewed. Five children underwent successful resection of congenital nasal lesions with intracranial extension via the subcranial approach. Lesions resected included nasal dermoids with intracranial extension (n = 3) and encephaloceles (n = 2). Patient age at the time of operation ranged from 13 months to 15 years. All lesions were resected successfully, and there have not been any recurrences. Follow-up has ranged from 1 to 12 years. There has been no apparent negative effect on facial growth in any of these patients. The subcranial approach is an effective technique for the resection of nasal masses with intracranial extension. These lesions have traditionally been managed with lateral rhinotomy, midface degloving, or external rhinoplasty approaches combined with a frontal craniotomy. The subcranial approach offers several advantages over a traditional frontal craniotomy. It provides excellent exposure, minimizes frontal lobe retraction, reduces the likelihood of cerebrospinal fluid leakage, and provides for an excellent cosmetic result. Long-term follow-up in 5 pediatric patients has shown no recurrence or negative effect on craniofacial growth. These factors make the transglabellar subcranial approach a useful and safe technique for the management of nasal lesions with intracranial extension in very young patients.

Nasal dermoids

Midline congenital nasal lesions are rare, occurring in one out of every 20,000-40,000 births. Of these midline lesions, nasal dermoids are the most common. This review centers on diagnosis of nasal dermoids, the role of imaging in diagnosis and surgical planning and the various approaches to surgical management of these lesions. Multiplanar, high-resolution thin section magnetic resonance imaging allows for excellent soft tissue detail, particularly when intracranial extension is expected. Open rhinoplasty is favored by many authors for excision of dermoids. Transnasal endoscopic excision of nasal dermoids has been reported but is not recommended for dermoids extending into or beyond the falx cerebri. Imaging of the midface and brain is essential for accurate diagnosis, assessment for any intracranial extension and appropriate surgical planning. Any surgical approach for removal of nasal dermoid cysts should permit adequate access, allow repair of the skull base and cerebrospinal fluid leak, facilitate nasal reconstruction and result in acceptable cosmesis. The head and neck surgeon should be able to consider various surgical approaches to manage these lesions.

Three-dimensional computed tomography of congenital nasal anomalies

Objective: To determine the utility of performing three-dimensional (3D) computed tomography (CT) of congenital naso-frontal anomalies for preoperative planning and counseling and compare it with standard two-dimensional (2D) imaging and intraoperative findings. Study Design: Prospective case evaluation of imaging studies and medical records in cohort of patients with congenital nasal anomalies. Methods: We performed 3D CT imaging of three different types of congenital nasal lesions. Additional preoperative imaging consisted of standard 2D CT scans and/or magnetic resonance imaging (MRI). Information obtained from the 3D CTs was compared with other standard imaging and intraoperative findings. Results: 3D CT was most useful in the case of a large encephalocele with a significant bony defect of the anterior cranial fossa. It provided moderate utility when used to evaluate a nasal dermoid with nasal bone and septal abnormalities and was of limited benefit in the case of a bifid nose with significant external soft tissue deformity and relatively normal bony anatomy. Conclusion: Congenital midline nasal anomalies are rare lesions with the potential for intracranial extension and anterior skull base abnormalities. The safe surgical treatment of these lesions depends upon accurate preoperative imaging to assist in establishing the diagnosis, to help guide surgical planning, and to assist in communicating the diagnosis and surgical approach for optimal counseling of families. 3D CT was instrumental in providing additional useful information in cases with significant bony abnormalities at little additional cost or time. It is also beneficial for preoperative counseling of patients and families with limited medical knowledge.