Nasal Dermoid Sinus Cysts Research Articles

Nasal dermoid sinus cyst with intracranial extension and atretic sinus tract in an adult patient

Nasal dermoid sinus cyst (NDSC) is a rare congenital lesion due to cephalic neural tube defect. It may also have been seen in other parts of the body. NDSC constitutes 1–3% of all dermoid cysts and 11–12% of those in the head and neck. A NDSC is located in the median line of the nasofrontal region from the glabella to the columella. The differential diagnosis based on location includes epidermal inclusion cyst, glioma, meningomyelocele, meningoencephalocele, teratoma, teratoid cyst, thyroglossal duct cyst, branchial cleft cyst, and benign lymphadenopathy. Intracranial extension causes serious complications such as meningitis, osteomyelitis, abscess formation, hydrocephalus, seizures, and personality changes. All patients with NDSC should be considered to have a potential intracranial extension and should, therefore, undergo pre-operative radiological evaluation. Herein, the authors report an unusual adult patient with NDSC with intracranial extension.

Transnasal Endoscopic Approach for Excision of Intracranial Nasal Dermoid Sinus Cysts.

Nasal dermoid sinus cysts (NDSCs) with intracranial extension in the form of dermal sinus tracts require careful and complete resection to prevent recurrence. Resection techniques necessitate adequate intracranial exposure, but morbidity associated with historical resection approaches has presented unique multidisciplinary challenges for surgeons treating cysts with intracranial extension. The authors primarily employed a transnasal approach through a midline nasal incision, utilizing endoscopic or microscopic access between the lateral cartilages for resection of NDSCs with intracranial extension. A retrospective review was completed for patients treated for NDSCs at the authors' pediatric quaternary referral center from 2017 to 2023. Data collection included demographics, comorbidities, perioperative data, pre and postoperative imaging, surgical outcomes, and complications. Eighteen patients with NDSCs with possible or confirmed intracranial extension were surgically treated from 2017 to 2023. Fifteen were treated with resection performed through a midline transnasal approach with endoscopic assistance, achieving successful total resection while avoiding nasal osteotomy or frontal craniotomy. One patient had a slow cerebrospinal fluid leak from an operative durotomy, successfully treated with a lumbar drain. No other complications occurred. No patients required transfusion. Incision length and postoperative scar burden were less than approaches that used osteotomies or craniotomies and demonstrated excellent cosmetic results. No patients have had cyst recurrence or required reoperation. A transnasal approach through a midline incision with endoscopic assistance is an effective approach for resection of NDSC with intracranial extension, but utility may vary with cyst size and complexity. This approach leverages appropriate exposure for resection with decreased morbidity and decreased incision length through avoidance of osteotomies.

Nasal Embryonal Rhabdomyosarcoma in the Pediatric Population: Literature Review and Report of Midline Presentation.

Background:Congenital midline nasal masses are rare anomalies and are typically benign nasal dermoid sinus cysts (NDSCs). Rhabdomyosarcomas (RMSs) are even less common, and only a fraction affect sites like the external nose, nasal cavity, nasopharynx, and paranasal sinuses. We review the clinical presentation and treatment of nasal, nasopharyngeal, and paranasal RMSs and report the first documented midline presentation.Methods:We queried PubMed for articles with titles containing the terms rhabdomyosarcoma or sarcoma botryoides and nose, nasal, paranasal, sinonasal, nasopharynx, or nasopharyngeal. We then searched the references of each included article using the same parameters and continued this process iteratively until no new articles were found.Results:The paranasal sinuses were the most commonly affected site, followed by the nasopharynx, nasal cavity, and external nose. Two patients presented with involvement of the external nose, but each presented with involvement of the right ala rather than a midline mass. The rates of intracranial extension and/or skull base involvement were comparable to those of NDSCs. The alveolar subtype was most common, followed by the embryonal subtype.Conclusions:Most midline nasal masses are benign; however, we report the first documented presentation of an RMS as a midline nasal mass. Accordingly, RMS should be included in the differential diagnosis of midline nasal masses in the pediatric population. Surgery for midline nasal masses is sometimes delayed due to the risks of interfering with developing structures and early anesthesia. However, early surgical treatment should be considered given this new differential and its predilection for early metastasis.

International Journal of Surgery Research and Practice

Nasal dermoid sinus cyst (NDSC) is a rare congenital lesion, typically presenting at birth or in early infancy. Treatment of NDSC includes complete resection of the mass and the sinus tract, which may extend intracranially. Incomplete resection of the track is associated with high recurrence. We were looking for methods to delineate the NDSC track, without increasing the financial burden to the patient.

Progress of the diagnosis and treatment of congenital nasal dermoid sinus cysts

Congenital midline nasal masses are rare. Nasal dermoid sinus cysts（NDSC） are the most common type of the congenital midline nasal masses in childhood. Clinical manifestations are midline nasal cysts, fistula and intracranial attachments. Nasal encephalocele and glioma should be included in the differential diagnosis. Radiologic images are instructive. NDSC are easily misdiagnosed, leading to recurrence and surgical trauma affecting the face. Early appropriate surgical excision is recommended. This article reviews the embryology pathogenesis, progress of diagnosis and treatment of congenital NDSC.

Pediatric nasal dermoid- a decade's experience from a South Indian tertiary care centre

IntroductionNasal dermoid sinus cyst (NDSC) are uncommon congenital lesions in children. ObjectiveTo review the clinical and radiological presentation and study the surgical outcomes of this uncommon lesion. MethodRetrospective chart review of all children diagnosed with nasal dermoid from 2010 to 2020 at a tertiary referral hospital in South India was executed. The medical records were reviewed for demographics, lesion characteristics, imaging, operative details, and outcomes and literature review was performed. ResultA total of 25 children [Mean age 3.7 yrs (Range 2–9 yrs)] with nasal dermoid sinus cysts were treated in the last decade. While 13 presented with a sinus, 11 presented with cyst and 1 had both. The lesions mainly involved the upper third of the nose in 10 children, middle one third in 6 and upper one third in 9 children. All underwent Magnetic Resonance Imaging, in 11 Computed Tomography also was done. A flow chart of the lesion characteristics and its management has been presented. Intraoperatively intracranial extension was present in four children. The approach to intracranial extension and corresponding literature review has been presented. Follow up ranged from one to six years. (Median 3.5 yrs) and no recurrence or complication was noted. ConclusionNasal dermoid is an uncommon congenital anomaly. Preoperative evaluation must include imaging to assess extent and rule out intracranial extension. Surgical strategy depends on whether presentation is as sinus or cyst and location and extent of lesion. All surgical approaches have a good surgical and cosmetic outcome.

Combined minimally invasive surgical management of a nasal dermoid sinus cyst affecting the frontal sinus: literature review and new classification.

IntroductionNasal dermoid sinus cysts (NDSCs) are the most common lesions associated with midline craniofacial anomalies, in the majority of cases diagnosed during childhood. NDSCs affecting the frontal sinus are rare.AimTo demonstrate the clinical, radiological and diagnostic pitfalls of NDSCs affecting the frontal sinus.Material and methodsA retrospective analysis of NDSCs affecting the frontal sinus with a literature review and a novel classification is presented.ResultsWe present a rare and complex case of an NDSC in an adult patient that affected the frontal sinus. Endoscopic-assisted open rhinoplasty with endoscopic sinus surgery – Draf type 2B approach – was performed as an effective removal method of choice. A literature review supports our report.ConclusionsNDSCs affecting the frontal sinus can mimic complications of sinusitis. A minimally invasive combined technique of endoscopic-assisted open rhinoplasty with endoscopic sinus surgery – Draf type 2B frontal sinus approach – is recommended for treatment.

A Nasal Dermoid Sinus Cyst with Intracranial Extension into the Anterior Cranial Fossa in a 4-Year Old Child; A Case Report

A Nasal Dermoid Sinus Cyst with Intracranial Extension into the Anterior Cranial Fossa in a 4-Year Old Child; A Case Report

Ultrasound Evaluation of Dermal Sinuses/Fistulas in Pediatric Patients.

A dermal sinus/fistula is a common condition; the relevant department should be consulted for appropriate treatment. It is important for radiologists to have adequate knowledge of these conditions to provide the correct diagnosis and recommend subsequent management. This review describes the following lesions: preauricular sinus, midline sinus of the upper lip, nasal dermoid sinus cyst, cheek fistula, first branchial cleft anomaly/sublingual branchial cleft anomaly, thyroglossal duct cyst/fistula, lateral cervical sinus/fistula, congenital dermal sinus/fistula of the anterior chest region, congenital skin sinus/fistula with a sternal cleft, and congenital prepubic sinus. On the basis of the skin orifice location and ultrasound images, radiologists can provide useful information to physicians.

Resection of intracranial nasal dermoid sinus cyst by endoscopic-assisted open rhinoplasty approach

Resection of intracranial nasal dermoid sinus cyst by endoscopic-assisted open rhinoplasty approach

Congenital Nasal Dermoid Sinus Cyst in Children

Background: Nasal dermoid sinus cyst is a rare congenital anomaly affecting approximately 1 in 20,000–40,000 live births. It is liable for infection and may communicate with the central nervous system. The treatment is complete surgical excision. Case history: Nine months old male presented by a pea-size fronto-nasal swelling over the nasal bridge since birth, gradually increasing in size with recent history of local redness and discharge. Sagittal CT of the skull showed osteolytic lesion at the fronto-nasal bone with eroded inner and outer tables). MRI showed no intracranial extension. Surgical excision was done by combined nasal and bicoronal incisions. A big abscess cavity was encountered at the fronto-nasal bone junction. The diagnosis of Nasal dermoid sinus cyst was confirmed by histopathology. The patient was followed in the outpatient clinic; MRI was done after one month. No recurrence was detected.

Congenital Midline Nasal Mass: Four Cases with Review of Literature

Introduction
 Congenital midline nasal masses include nasal dermoids, gliomas, encephaloceles. Although rare, these disorders are clinically important because of their potential for connection to the central nervous system. Preoperative knowledge of an intracranial connection is a necessity to allow for neurosurgical consultation and possible planning for craniotomy. This study discusses the clinical presentation of congenital midline nasal mass and the role of imaging modalities like CT scan and MRI in diagnosis and the surgical management.
 Materials and Methods
 This prospective study is carried from March 2014 to March 2016, during which 4 cases presented to the Otorhinolaryngology department. Pre-operative evaluation of the patients included endoscopic evaluation along with haematological investigations, CT Scan and MRI. The masses were removed with nasal endoscopic sinus surgery or by external approaches and neurosurgical intervention.
 Result
 The age of the patients ranged from 3 years to 25 years. Three of them were male and one female. There was one case of nasoethmoidal encephalocele and the other three were dermoids (intranasal dermoid cyst, nasal dermoid cyst and nasal dermoid sinus cyst).
 Conclusion
 Congenital midline nasal masses are rare. These disorders are clinically important because of their intracranial connection which require proper evaluation with radiological imaging like CT scan and/or MRI before FNAC and any surgical intervention.

Midline Nasal Dermoid - A Series of Thirteen Cases and Review of Literature

Introduction
 Congenital midline nasal masses include nasal dermoid sinus cysts, encephaloceles and gliomas. They are rare malformations, of which dermoid cyst is a relatively common congenital abnormality. A systematic review of the clinical feature and management outcome of congenital midline nasal dermoids would help in predicting the outcome of such cases.
 Materials and Methods
 A prospective observation was made on a series of patients with nasal dermoids with or without sinus tract for a period of three years. Altogether thirteen patients were evaluated. Age of the patients ranged from two to twenty seven years. There were seven males and six females. Intracranial extension was ruled out radiologically. Excision of the dermoid cyst with or without sinus tract was undertaken under general anesthesia and followed up for one year. 
 Conclusion
 Surgery is the gold standard treatment for nasal dermoids and complete excision and cosmetically good repair is mandatory for good results.

Nasal Tip Dermoid Sinus Cyst Excision by Open Rhinoplasty Technique

AbstractNasal dermoid sinus cysts are uncommon congenital anomalies, presenting either as cysts or sinuses with varied presentation at birth, childhood, or even adulthood. A midline nasal pit, fistula, or infected mass may be located anywhere from the glabella to the nasal columella. Preoperative radiological investigation with CT (computed tomography) and MRI (magnetic resonance imaging) scans is mandatory to rule out intracranial extension. Complete excision of the cyst along with its tract is the only definitive therapeutic modality. We present a case of nasal dermoid sinus cyst in a 3-year-old male child who underwent excision by open rhinoplasty approach.

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

The most common congenital midline nasal masses are nasal dermoid sinus cysts (NDSC) [Hughes GB, Sharpino G, Hunt W, Tucker HM. Management of the congenital midline nasal mass—a review. Head Neck Surg 1980;2:222–33.1]. Their clinical importance hinges on their potential to communicate with the central nervous system. Preoperative diagnosis of an intracranial extension allows for referral to a craniofacial team with the appropriate skills and experience for a transcranial approach. All patients with a NDSC require imaging with high resolution multiplanar MRI scans and complimentary fine cut CT scan to reveal the anatomical extent of the tract and its relationship to the anterior cranial fossa.A single-stage craniofacial approach to resection of midline NDSC extending to the anterior cranial base is effective with minimal morbidity [Yavuzer R, Bier U, Jackson IT. Be careful: it might be a nasal dermoid cyst. Plast Reconstr Surg 1999;103:2082–3; Denoyelle F, Ducroz V, Roger G, Garabedian EN. Nasal dermoid sinus cysts in children. Laryngoscope 1997;107:795–800; Rohrich RJ, Lowe JB, Schwartz MR. The role of open rhinoplasty in the management of nasal dermoid cysts. Plast Reconstr Surg 1999;104:2163–70; Rahbar R, Shah P, Mulliken JB, et al. The presentation and management of nasal dermoid—a 30-year experience. Arch Otolaryngol Head Neck Surg 2003;129:464–71; Posnick JC, Bortoluzzi P, Armstrong DC, Drake JM. Intracranial nasal dermoid sinus cysts: computed tomographic scan findings and surgical results. Plast Reconstr Surg 1994;93:745–54 [discussion 755–56]; Bartlett SP, Lin KY, Grossman R, Kratowitz J. The surgical management of orbitofacial dermoids in the pediatric patient. Plast Reconstr Surg 1993;91:1208–15.2, 3, 7, 9, 11, 18]. The cyst and tract are accessed through a combination of a nasal and transcranial approach. This allows visualisation and dissection of the tract with only a small incision on the nasal dorsum to include the cutaneous punctum when present. Transnasal endoscopic techniques have been advocated where the dermoid is located within the nasal cavity and there is little or no cutaneous involvement [Weiss DD, Robson CD, Mulliken JB. Transnasal endoscopic excision of midline nasal dermoid from the anterior cranial base. Plast Reconstr Surg 1998;101:2119–23.26].We present a review of five cases referred to our unit between 1999 and 2004 with a diagnosis of a midline nasal dermoid sinus cyst and radiological evidence of intracranial communication. All cases had a communication with the anterior cranial fossa diagnosed preoperatively and were treated surgically with a craniofacial approach. An intracranial extension was identified at operation in each case and this was confirmed on histopathology. The only significant complication resulted from an early postoperative infection, requiring re-operation. There were no recurrences and acceptable aesthetic outcomes have been observed in all cases.

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.

Craniofacial anomalies with toothy nose

A simple subcutaneous lesion such as an epidermoid cyst can present as an aesthetic challenge when located in the nasal tip. Usually the nasal dermoid presents as swelling over the dorsum of nose extending from the nasal tip to the nasal bridge with or without intracranial extensions. In some cases, the overlying skin gets rupture and underlying abnormal structures developed from pluripotent cells of dermoid become visible with variable discharges such as cerebrospinal fluid or sequestrum. Origin of nasal dermoid sinus cyst (NDSC) during embryological development requires two necessary and sufficient conditions. One is competence of the ectodermal and meso-ectodermal cells to form dermoid tissue with epithelial-mesenchymal interactions and second, presence of a topographical site of ectodermal inclusion, which fits well with the various clinical presentations of NDSCs. The case presented here has naso-ethmoidal dermoid cyst with ectopic teeth at the tip of the nose. The patient had a cranial defect with bulging of tissue in naso-ethmoidal region that was in line of 1-13 facial cleft of Tessier. Computerized tomography revealed a bony gap in the region of right fronto-ethmoidal region and brain cyst with craniosynostosis in left frontoparietal suture. Transcranial approach was used to manage the case and all the teeth at the tip of the nose were removed.

The “Stepped Caudal Exposure” Technique for Excision of Nasal Dermoids With Intracranial Extension

Nasal dermoid sinus cysts (NDSCs) are rare congenital malformations derived from ectodermal and mesodermal tissues. There are numerous reports on surgical approaches for extirpation of NDSCs with intracranial extension. Here we describe the "stepped caudal exposure" approach, a technique that minimizes the risk for bacterial infection of the central nervous system from the nasal space. This procedure involves a stepwise osteotomy of the frontal and nasal bones that permits sufficient exposure to allow complete extirpation of NDSCs; it was used successfully to treat a 20-month-old boy with NDSC extending into the intracranial space and an infectious abscess. After NDSC extirpation and debridement of the abscess, the anterior skull base was reconstructed with bone grafts placed on both the intracranial and intranasal sides of the widened foramen cecum. Thereafter, each graft was covered by frontal pericranial flaps for blood supply. These modified surgical techniques may enhance the safety of surgical removal of NDSC, particularly in cases accompanied by infectious lesions such as abscesses.

Our Experiences with Congenital Midline Nasal Dermoid Sinus Cyst

ABSTRACT Introduction Nasofrontal dermoid sinus cysts (NDSC) are rare congenital malformations. NDSCs are distinct from other facial dermoids in their potential for involving deeper contiguous structures and intracranial extension. The development of this congenital midline sinus of dorsum of nose has opened a new horizon in current concepts of embryology. Objective To study the embryological origin, presentation, treatment, and genetic associations of three cases of these sinus cysts. Clinical presentation This paper presents our experiences with managing three patients who presented with opening on nasal dorsum with recurrent swelling and purulent discharge from it. Imaging studies in these patients indicated a midline anterior nasal sinus tract with cranial dilatation but no intracranial connection. They were successfully managed surgically. Conclusion Nasofrontal dermoid sinus cysts have a unique embryological origin. A midline basal frontal dermoid associated with a dimple or sinus opening on the nasal dorsum with or without protruding hair and sebaceous discharge is the classical presentation. The purpose of this report is to emphasize that, though rare nasofrontal dermoid sinus cysts do occur in our practice and their clinical importance from rhinology point of view is their potential for intracranial communication. How to cite this article Maru Y, Gupta Y. Our Experiences with Congenital Midline Nasal Dermoid Sinus Cyst. Clin Rhinol An Int J 2014;7(1):43-46.

Treatment outcomes of pediatric rhinoplasty: The Asan Medical Center experience

ObjectivePerforming rhinoplasty in children has been an issue of some debate due to concerns about potential harmful effects on nasoseptal growth. However, there is a paucity of evidence describing the outcomes of pediatric rhinoplasty. This study presents our experience of performing this procedure in children of 17 years of age and younger. MethodsThe study population consisted of 64 Korean children between 4 and 17 years of age who underwent rhinoplasty between May 2003 and August 2011. Forty-six of the patients were boys and 18 were girls with a mean follow-up period of 59 months. The diagnosis of the patients, the extent of the surgical maneuver performed, and the surgical outcomes were reviewed. Subjective satisfaction of the patients was investigated by telephone interview. Surgical outcomes, which were judged by two independent ENT surgeons, were evaluated by comparing preoperative and postoperative photographs. Satisfaction scores were graded using a visual analog scale (from 1=satisfied, to 4=dissatisfied). Anthropometric measurements of nasal parameters were performed preoperatively and postoperatively. ResultsRhinoplasty was performed in our patient cohort due to a deviated nose (32.8%), nasal bone fracture (18.8%), flat nose (6.3%), nasal mass (4.7%), hump nose (3.1%), nasal dermoid sinus cyst (1.6%), and additional cosmetic rhinoplasty for planned septoplasty (32.8%). The median patient satisfaction score was 2.09 compared with a median doctor satisfaction score of 1.81. Anthropometric measurements showed statistically significant improvements in nasal tip projection, nasal length, dorsal height, and radix height after rhinoplasty. Seventeen patients (26.6%) experienced esthetic dissatisfaction such as deviation, tip depression, bulbous tip, short nose, and nostril asymmetry. Eight patients (12.5%) experienced postoperative difficulty in nasal breathing, and two patients (3.1%) complained of transient nasal pain after rhinoplasty. Six patients (9.4%) underwent revision surgery, and four patients (6.3%) were seriously considering a revision operation. ConclusionsThe outcome analysis in our series reveals that rhinoplasty in children is complicated by a high rate of revision and esthetic dissatisfaction. The results of this study may indicate that surgeons should have a conservative attitude and apply strict indication in selecting pediatric rhinoplasty candidates.