Nasal Cyst Research Articles

Case Report: Congenital Dacryocystocele and Dacryocystitis

Congenital dacryocystocele is a uncommon type of nasolacrimal duct obstruction. Differential diagnosis for masses in the medial canthal region of a newborn include encephalocele, hemangioma, nasal glioma, and dermoid cyst. Because of the risk of becoming infected (acute dacryocystitis) and potentially lethal due to septicemia, aggressive management, including admission for intravenous antibiotics and surgical removal, is now advocated by many pediatric ophthalmologists if the cyst cannot be decompressed. Because of the commonly associated nasal cyst, infants with nasolacrimal dacryocyctocele may also experience respiratory distress especially when breast-feeding. The following case of dacryocystocele, which had progressed to dacryocystitis, was misdiagnosed as an infantile hemangioma. It is important to diagnose this entity quickly and refer for appropriate antibiotic and surgical management to avoid more serious sequelae of sepsis and possible death.

Inclusion Mucous Cysts of the Nose: A Late Complication after Septorhinoplasty in Two Cleft Lip Patients

Mucous cysts of the nose are a rare complication of rhinoplasty. They may develop as a result of implantation or herniation of mucosa. The entrapped epithelium may proliferate, forming a subcutaneous cyst. Two patients with unilateral cleft lip nose deformity had previously undergone corrective rhinoplasty. Years after the operation, they noticed a growing mass in the nasal dorsum and presented for revision rhinoplasty. Complete surgical removal was performed by an open approach, and plastic reconstruction was performed with a rib cartilaginous graft. In both cases, histopathological investigation revealed a mucous cyst. No recurrence of disease was observed over 2 years of monitoring. Nasal mucous cysts are not specific complications of corrective surgery for cleft lip nose. Displacement of fragments of epithelium should be avoided to prevent this unwanted sequela. For complete removal, open rhinoplasty is recommended.

Minimal Invasive Surgery in Head and Neck

The recent advent of endoscopic procedures has compelled plastic surgeons to reconsider the conventional methods by which the excision of different types of head and neck tumors are classically achieved. Endoscopic resection is a safe and minimally invasive approach and spares unnecessary discomfort to the patient. This article describes the authors' method for performing a video-assisted surgery for extirpation of benign tumors as branchiogenic cysts, frontal tumors, frontocygomatic cysts, epidermic nasal cysts, and submandibular and sublingual gland diseases. One hundred eight patients were operated on from August 1999 to September 2007 in the Department of Plastic Surgery at the Argerich Hospital of Buenos Aires, Argentina. In all the cases, 3 basic surgical steps were planned: (1) incision, (2) exposure of the tumor, and (3) resection. An endoscope of 20 cm long with a diameter of 4 mm and a vision angle of 0 degree was used. Special curved and righted dissectors, delicate conventional or endoscopic scissors, clamps, and forceps were also used. Transnasal and transoral approaches such as natural orifice surgery were performed in the treatment of nasal cysts and submandibular and sublingual diseases. This experience highlights the video-assisted surgery, demonstrating excellent illumination and a magnified view of the dissection areas, small or hidden incisions, excellent postoperative comfort, and short hospital stay. With the arrival of new surgical techniques, surgeon experience, and advanced endoscopic instruments, the video-assisted surgery can be a safe method of choice in the treatment of the several diseases of the head and neck areas.

Nasal Hair Matrix Cyst Mimicking Dermoid Cyst

Dermoid cysts are primarily observed in the head and neck region. Nasal dermoids are uncommon. The terms nasal dermoid, nasal epidermoid, and nasal sebaceous cysts are used interchangeably by clinicians. Hair matrix cyst is a variant of epidermal cyst resembling the pattern of pilomatrixoma. Formerly, nasal hair matrix cyst has not been reported at all. Here, an additional pathologic proof is presented as well.

Nasal dorsal granuloma after nasal bone fracture

A granuloma on the nasal dorsum after nasal bone fracture is a rare complication, like postrhinoplasty nasal cysts which were previously rarely reported. The authors describe five cases of nasal dorsal granuloma following nasal bone fracture reduction. Rubbery hard non-tender fixed masses were noted in the nasal root area 1 to 10 months after nasal bone reduction. The masses were managed by excision using a direct percutaneous approach. Histopathologic findings were of chronic granulomatous inflammation with infiltrations of epitheloid cells and Langerhans' giant cells and necrosis-like tuberculous tubercles. Acid-fast bacilli (AFB) stains were negative. The exact cause of this granuloma is not known, but imbedded free mucosal fragment or effused antibiotic ointment of packed gauze through the fracture site, which could cause a tissue reaction, is thought to be the cause of the granuloma. In order to prevent this rare complication, we recommend that aggressive practices and overpacking should be avoided during nasal bone reduction.

Foreign Body Inclusion Cyst of the Nasal Radix after Augmentation Rhinoplasty

Development of a cystic mass on the nasal dorsum is a very rare complication of aesthetic rhinoplasty. Most reported cases are of mucous cyst and entrapment of the nasal mucosa in the subcutaneous space due to traumatic surgical technique has been suggested as a presumptive pathogenesis. Here, we report a case of dorsal nasal cyst that had a different pathogenesis for cyst formation. A 58-yr-old woman developed a large cystic mass on the nasal radix 30 yr after augmentation rhinoplasty with silicone material. The mass was removed via a direct open approach and the pathology findings revealed a foreign body inclusion cyst associated with silicone. Successful nasal reconstruction was performed with autologous cartilages. Discussion and a brief review of the literature will be focused on the pathophysiology of and treatment options for a postrhinoplasty dorsal cyst.

Congenital Dacryocystocele with Intranasal Extension

Congenital dacryocystocele is a rare anomaly in the newborn child. The swelling of lachrymal sac is observed by birth and it is associated with obstruction of lachrymal system either above or below lachrymal sac. Diagnosis was made by clinical observation. Some ancillary examinations, such as ultrasonography, tomography, and rhinoscopy, were useful. The authors describe the clinical case of a newborn with a unilateral congenital dacryocystocele. This anomaly was successfully treated with probing and marsupialization of the nasal cyst. Treatment of this congenital anomaly is by light compressive massage, probing with silicone intubation of lachrymal system to assure prolonged permeability of the system, or with marsupialization of the nasal cyst. In some cases with intranasal extension of dacryocystocele, collaboration with an otolaryngologist may be necessary.

Nasal endoscopy in the treatment of congenital lacrimal sac mucoceles

Purpose: To determine the incidence of intranasal cysts associated with lacrimal sac mucoceles and the cure rate with nasal endoscopic cyst marsupialization. Design: Interventional case series. Methods: Setting: University-affiliated teaching hospital. Patient Population: Twenty-five infants with non infected or infected lacrimal sac mucoceles or dacrocystitis without obvious mucocele were consecutively enrolled. Intervention Procedures: Management included local lacrimal massage, parenteral antibiotics, and when still symptomatic, nasolacrimal duct probing with concomitant nasal endoscopy. Intranasal cysts identified were marsupialized until the distal end of the nasolacrimal duct probe was visualized. Main Outcome Measures: Presence of intranasal cyst identification and cure rate. Results: Infants were 4 days to 10 weeks old (mean 19 days). Forty-eight percent had a bluish cutaneous mass inferior and lateral to the lacrimal sac. Twenty percent were bilateral. At presentation, 76 percent had dacrocystitis. Fourteen percent had respiratory distress. Only one child responded to medical management. At endoscopy, 23 of 24 infants had ipsilateral intranasal cysts. The one child without nasal cyst had recurrent dacrocystitis and no mucocele. All children with mucocele were cured except one child with residual nasolacrimal duct obstruction. Conclusions: Lacrimal sac mucoceles were almost always associated with intranasal cysts. Nasal endoscopy is a valuable addition to the treatment plan for lacrimal sac mucoceles not responding to a brief trial of massage or infantile dacrocystitis. To avoid potential complications, we recommend against waiting until infection occurs before proceeding with surgery.

Nasofrontal Dermoid Sinus Cyst: Report of Two Cases

Nasofrontal dermoid sinus cysts are rare. The embryological origin, presentation, treatment, and genetic associations of two cases of these cysts are discussed. Emphasis is placed on physical findings and the importance of addressing both the intracranial and extracranial components. The first patient, a 33-year-old woman, sought care for chemical meningitis. As a child, she was differentiated from her identical twin sister by a dimple on the tip of her nose. The second patient, a 34-year-old man, sought care for new-onset seizures. Since birth, he had a dimple on the tip of his nose. As a child, he had undergone resection of a nasal cyst. Imaging studies in both patients indicated a midline anterior cranial base mass within the falx and a defect in the crista galli. Both patients underwent biorbitofrontal nasal craniotomy. A bifrontal craniotomy was performed first, then removal of the orbitonasal ridge. The dermoid and involved falx were resected. The sinus tract was followed through the crista galli and resected up to the osteocartilaginous junction in the nose. The remainder of the tract was resected via a small incision through the nares. The dura was closed primarily by mobilizing the dura along the sides of the crista galli. After surgery, both patients still possessed their sense of smell. Nasofrontal dermoid sinus cysts have a unique embryological origin. A midline basal frontal dermoid associated with a dimple on the nasal surface with or without protruding hair and sebaceous discharge is the pathognomonic presentation. It is important to address both the intracranial and extracranial component surgically. Although concomitant anomalies and familial clustering have been described, most cases are spontaneous occurrences.

Nasofrontal Dermoid Sinus Cyst: Report of Two Cases

Nasofrontal dermoid sinus cysts are rare. The embryological origin, presentation, treatment, and genetic associations of two cases of these cysts are discussed. Emphasis is placed on physical findings and the importance of addressing both the intracranial and extracranial components.The first patient, a 33-year-old woman, sought care for chemical meningitis. As a child, she was differentiated from her identical twin sister by a dimple on the tip of her nose. The second patient, a 34-year-old man, sought care for new-onset seizures. Since birth, he had a dimple on the tip of his nose. As a child, he had undergone resection of a nasal cyst. Imaging studies in both patients indicated a midline anterior cranial base mass within the falx and a defect in the crista galli.Both patients underwent biorbitofrontal nasal craniotomy. A bifrontal craniotomy was performed first, then removal of the orbitonasal ridge. The dermoid and involved falx were resected. The sinus tract was followed through the crista galli and resected up to the osteocartilaginous junction in the nose. The remainder of the tract was resected via a small incision through the nares. The dura was closed primarily by mobilizing the dura along the sides of the crista galli. After surgery, both patients still possessed their sense of smell.Nasofrontal dermoid sinus cysts have a unique embryological origin. A midline basal frontal dermoid associated with a dimple on the nasal surface with or without protruding hair and sebaceous discharge is the pathognomonic presentation. It is important to address both the intracranial and extracranial component surgically. Although concomitant anomalies and familial clustering have been described, most cases are spontaneous occurrences.

Interdisciplinary endoscopic outpatient management of connatal dacryocystoceles

Dacryocystocele may represent a rare type of connatal stenosis of the lacrimal duct. If conservative measures fail and in case of secondary inflammation, probing or regular surgery is usually recommended. We report on 15 neonates suffering from 18 connatal dacryocystoceles which were presented to the clinic of ophthalmology at the 16th (6 - 44) day of life. There was a definite female preponderance (65 %). Conservative treatment (external massage, at times i. v. antibiotic therapy) had proven to be ineffective. The neonates were subjected to outpatient nasal endoscopy and the ballooning cyst of the inferior nasal meatus was managed by endoscopic marsupialization in 14 cases applying local anesthesia. Two nasal cysts had to be operated on in general anesthesia due to obstructing local anatomy which obviated endoscopical microsurgery. Three additional dacryocystoceles have been detected incidentally in 2 neonates being subjected to surgery in general anesthesia for choanal atresia and lacrimal probing respectively. The corresponding dacryocystoceles were managed by concomitant endonasal microsurgery. We advocate interdisciplinary (ophthalmological and rhinological) outpatient examination in all neonates with suspected dacryocystoceles. Diagnosis is based on palpation, probing and nasal endoscopy applying local anesthesia together with mucosal decongestion. Microsurgical marsupialization immediately follows and will lead to persisting relief of symptoms.

Nasal Dorsal Pseudocyst Formation after Rhinoplasty

Nasal dorsal cyst or pseudocyst formation is a rare complication after rhinoplasty. We present what we believe to be the first case in which extensive bony destruction resulted from such a lesion. A review of the literature is provided along with a discussion of possible etiologies of this complication.

Congenital Dacryocele: A Collaborative Review

Fifty-four cases of congenital dacryocele from several medical centers were reviewed retrospectively. There was strong female preponderance (73%) and unilateral involvement (88%). Lacrimal sac contents could be expressed by local massage through the puncta in 21 % of cases. Probing and irrigation were done under general (27.8%) or local (55.6%) anesthesia, while in other cases (16.7%), the cyst resolved before intervention. Recurrence of the dacryocele occurred in 10 patients (22%) after probing. Nasal cysts were visualized in six cases. Marsupialization of nasal cysts was necessary in four cases. In one center, after conservative therapy, 80% of cysts resolved spontaneously and 20% developed dacryocystitis. Surgical intervention is indicated in cases of dacryocystitis, cellulitis, breathing difficulty from large nasal cysts, recurrent dacryocele, and lack of its resolution after a short trial of digital massage. Ophthalmology 1991; 98:1744-1751

Dorsal Nasal Cyst Formation: A Rare Complication of Cosmetic Rhinoplasty

A dorsal nasal cyst is a rare complication of cosmetic rhinoplasty. The cause of this complication is unknown; however, entrapment of nasal mucosa and subsequent growth through osteotomy sites are thought to be the basis for formation of these masses. We describe two patients with these dorsal nasal cysts and provide a review of the English-language literature. The maintenance of mucosal integrity together with the meticulous removal of debris from the operative site may prevent postrhinoplasty nasal cysts.

Nasal cysts and the facial cleft cyst theory.

Nasal cysts and the facial cleft cyst theory.