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Woodyard De Brito KC, Dembinski DR, Lawera NG, Buller M, de Alarcon A, Pan BS, Skoch J. Transnasal Endoscopic Approach for Excision of Intracranial Nasal Dermoid Sinus Cysts. J Craniofac Surg 2024:00001665-990000000-01907. [PMID: 39254437 DOI: 10.1097/scs.0000000000010582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 07/22/2024] [Indexed: 09/11/2024] Open
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Kiersten C Woodyard De Brito
- Division of Craniofacial and Pediatric Plastic Surgery, Department of Surgery, Cincinnati Children's Hospital
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Cincinnati
| | - Douglas R Dembinski
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Cincinnati
| | - Nathan G Lawera
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Cincinnati
| | - Mitchell Buller
- Division of Craniofacial and Pediatric Plastic Surgery, Department of Surgery, Cincinnati Children's Hospital
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology, Department of Surgery, Cincinnati Children's Hospital
| | - Brian S Pan
- Division of Craniofacial and Pediatric Plastic Surgery, Department of Surgery, Cincinnati Children's Hospital
| | - Jesse Skoch
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital, Cincinnati, OH
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Hackenberg S, Renson A, Röseler SM, Baumann I, Topcuoglu MSY, Hebestreit H. Pädiatrische Rhinologie. Laryngorhinootologie 2024; 103:S188-S213. [PMID: 38697148 DOI: 10.1055/a-2178-2957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
The following review article highlights key topics in pediatric rhinology that are currently the focus in research and at conferences as well as in the interdisciplinary discussion between otorhinolaryngologists and pediatricians. In particular, congenital malformations such as choanal atresia or nasal dermoid cysts are discussed, followed by statements on the current procedures for sinogenic orbital complications as well as on the diagnosis and therapy of chronic rhinosinusitis in children. Furthermore, updates on the role of the ENT specialist in the care for children with cystic fibrosis and primary ciliary dyskinesia are provided.
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Affiliation(s)
- Stephan Hackenberg
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Würzburg
| | - Ariane Renson
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Uniklinik RWTH Aachen
| | - Stefani Maria Röseler
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Uniklinik RWTH Aachen
| | - Ingo Baumann
- Hals-, Nasen- und Ohrenklinik, Universitätsklinikum Heidelberg
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Amin SN, Siu JM, Purcell PL, Manning JP, Wright J, Dahl JP, Hauptman JS, Hopper RA, Lee A, Manning SC, Perkins JN, Susarla SM, Bly RA. Preoperative Imaging and Surgical Findings in Pediatric Frontonasal Dermoids. Laryngoscope 2024; 134:1961-1966. [PMID: 37776254 DOI: 10.1002/lary.31079] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/21/2023] [Accepted: 09/15/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE To review cases of congenital frontonasal dermoids to gain insight into the accuracy of preoperative computed tomography (CT) and magnetic resonance imaging (MRI) in predicting intracranial extension. METHODS This retrospective study included all patients who underwent primary excision of frontonasal dermoids at an academic children's hospital over a 23-year period. Preoperative presentation, imaging, and operative findings were reviewed. Receiver operating characteristic (ROC) statistics were generated to determine CT and MRI accuracy in detecting intracranial extension. RESULTS Search queries yielded 129 patients who underwent surgical removal of frontonasal dermoids over the study period with an average age of presentation of 12 months. Preoperative imaging was performed on 122 patients, with 19 patients receiving both CT and MRI. CT and MRI were concordant in the prediction of intracranial extension in 18 out of 19 patients. Intraoperatively, intracranial extension requiring craniotomy was seen in 11 patients (8.5%). CT was 87.5% sensitive and 97.4% specific for predicting intracranial extension with an ROC of 0.925 (95% CI [0.801, 1]), whereas MRI was 60.0% sensitive and 97.8% specific with an ROC of 0.789 (95% CI [0.627, 0.950]). CONCLUSION This is the largest case series in the literature describing a single institution's experience with frontonasal dermoids. Intracranial extension is rare and few patients required craniotomy in our series. CT and MRI have comparable accuracy at detecting intracranial extension. Single-modality imaging is recommended preoperatively in the absence of other clinical indications. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1961-1966, 2024.
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Affiliation(s)
- Shaunak N Amin
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Jennifer M Siu
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Patricia L Purcell
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - James P Manning
- Utah Facial Plastics and Aesthetics, Salt Lake City, Utah, U.S.A
| | - Jason Wright
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - John P Dahl
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Jason S Hauptman
- Division of Pediatric Neurosurgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Richard A Hopper
- Division of Craniofacial Plastic Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Amy Lee
- Division of Pediatric Neurosurgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Scott C Manning
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - J Nathaniel Perkins
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Srinivas M Susarla
- Division of Craniofacial Plastic Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Randall A Bly
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
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Shalmiyev R, Devine A, Gonzalez S, Danckers M. Late-onset rupture of an intracranial dermoid cyst: a case report. J Med Case Rep 2024; 18:9. [PMID: 38185668 PMCID: PMC10773053 DOI: 10.1186/s13256-023-04322-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/13/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Dermoid cysts are developmental abnormalities occurring between the third and fifth week of embryogenesis. These lesions can initially develop as intracranial or extracranial and persist throughout the patient's lifetime. While generally benign, their symptoms can be due to mass effect or local irritation secondary to rupture and release of contents, typically presenting as headaches and seizures. Intracranial dermoid cysts are rare and comprise less than 1% of all intracranial lesions, with rupture occurring approximately 0.18% of the time. CASE PRESENTATION Our case describes a 42-year-old Hispanic female with a late-onset rupture of an intracranial dermoid cyst with associated new onset seizures. She underwent uncomplicated neurosurgical resection with mesh placement and was scheduled to follow-up as an outpatient. CONCLUSION To avoid rupture and associated sequelae in future patients, we recommend considering a more invasive approach as the initial strategy if internal cysts are relatively accessible.
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Affiliation(s)
- Richard Shalmiyev
- Division of Pulmonary and Critical Care Medicine, HCA Florida Aventura Hospital, 20900 Biscayne Blvd, Aventura, FL, 33180, USA.
| | - Adam Devine
- Division of Pulmonary and Critical Care Medicine, HCA Florida Aventura Hospital, 20900 Biscayne Blvd, Aventura, FL, 33180, USA
| | - Sheyla Gonzalez
- Department of Medicine, HCA Florida Aventura Hospital, 20900 Biscayne Blvd, Aventura, FL, 33180, USA
| | - Mauricio Danckers
- Division of Pulmonary and Critical Care Medicine, HCA Florida Aventura Hospital, 20900 Biscayne Blvd, Aventura, FL, 33180, USA
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Kohan J, McGee SA, Self Q, Ahern T, Hersey D, O'Malley DL, Ostby E. Operative options for extracranial nasal dermoid cysts: A meta-analysis. J Plast Reconstr Aesthet Surg 2024; 88:171-181. [PMID: 37983980 DOI: 10.1016/j.bjps.2023.10.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 09/21/2023] [Accepted: 10/23/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Nasal dermoid cysts are surgically treated using external incision, open rhinoplasty, transnasal endoscopy, or combined approaches. It is unclear how these approaches differ with regard to the incidence of adverse events. METHODS We conducted a systematic review of studies on the surgical management of midline nasal dermoids. Following data abstraction, we carried out a series of single-arm meta-analyses to estimate summary risks of recurrence and combined adverse events (recurrence, revision, infection, or readmission) according to the surgical approach. RESULTS Forty-three eligible studies published between 1958 and 2020 reported on 439 cases of nasal dermoid cysts. Treatment approaches included external incision (25 studies), rhinoplasty (15 studies), and transnasal endoscopy (5 studies). To our knowledge, no study has compared outcome incidence between the surgical approaches. External incision had the lowest summary incidence of both recurrence (1.78% [95% CI: 0.57%, 3.65%]) and combined adverse events (4.94% [95% CI: 2.72%, 7.77%]). Rhinoplasty had a higher incidence of recurrence (4.81% [95% CI: 0.91%, 11.6%]) and combined adverse events (8.32% [95% CI: 2.77%, 16.5%]), and transnasal endoscopy had the highest incidence of recurrence (the only reported adverse event; 7.89% [95% CI: 0%, 28.9%]). CONCLUSION Our results suggest that the incidence of adverse events was lowest among patients who were subjected to external incision for nasal dermoid removal. Incidence was higher for patients who underwent rhinoplasty and the highest for patients who underwent transnasal endoscopy. Future work on this topic should include well-designed prospective studies that compare rates of adverse events and cosmetic outcomes between surgical approaches.
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Affiliation(s)
- Joshua Kohan
- Larner College of Medicine, University of Vermont, Burlington, VT, United States.
| | - Shayan A McGee
- Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Quinn Self
- Larner College of Medicine, University of Vermont, Burlington, VT, United States; University of Vermont Medical Center, Division of Otolaryngology - Head & Neck Surgery, United States
| | - Thomas Ahern
- Division of Surgical Research, Burlington, VT, United States
| | - Denise Hersey
- University of Vermont Libraries, Burlington, VT, United States
| | | | - Erin Ostby
- Larner College of Medicine, University of Vermont, Burlington, VT, United States; University of Vermont Medical Center, Division of Otolaryngology - Head & Neck Surgery, United States
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Kotowski M. The Differential Diagnosis of Congenital Developmental Midline Nasal Masses: Histopathological, Clinical, and Radiological Aspects. Diagnostics (Basel) 2023; 13:2796. [PMID: 37685334 PMCID: PMC10486988 DOI: 10.3390/diagnostics13172796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/24/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
Developmental midline nasal masses including nasal dermoids (NDs), encephaloceles (EPHCs), and nasal glial heterotopias (NGHs) are a consequence of disrupted embryonal developmental processes in the frontonasal region. Surgery is the only method of treatment in order to prevent local and intracranial inflammatory complications as well as distant deformities of the facial skeleton. Due to their rarity, similar location, and clinical and radiological symptoms, meticulous preoperative differential diagnostics is mandatory. The aim of this thorough literature review was to present and discuss all clinical, histopathological, and radiological aspects of NDs, NGHs, and EPHCs that are crucial for their differential diagnosis.
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Affiliation(s)
- Michal Kotowski
- Department of Pediatric Otolaryngology, Poznan University of Medical Sciences, 60-572 Poznań, Poland
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Tam AKY, Zhu XL, Chow SMW, Lee SKJ, Lai CCF, Chan KY, Chu WCW, Tong MCF. Intracranial nasofrontal dermoid cyst and a hair in the nose tip without a sinus tract identified with single-staged combined approach excision done. Clin Case Rep 2023; 11:e7414. [PMID: 37251739 PMCID: PMC10220384 DOI: 10.1002/ccr3.7414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/07/2023] [Accepted: 05/10/2023] [Indexed: 05/31/2023] Open
Abstract
This is the first reported case of intracranial nasofrontal dermoid without sinus tract, with complete excision done in single-staged combined approach frontal craniotomy and open rhinoplasty, and satisfactory nasal reconstruction.
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Affiliation(s)
- Aurora Ka Yue Tam
- Department of Otorhinolaryngology, Head and Neck Surgery, Prince of Wales HospitalThe Chinese University of Hong KongHong KongChina
| | - Xian Lun Zhu
- Department of Neurosurgery, Department of Surgery, Prince of Wales HospitalThe Chinese University of Hong KongHong KongChina
| | - Samuel Man Wai Chow
- Department of Otorhinolaryngology, Head and Neck Surgery, Prince of Wales HospitalThe Chinese University of Hong KongHong KongChina
| | - Shui Kwong John Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, Prince of Wales HospitalThe Chinese University of Hong KongHong KongChina
| | - Calvin Chee Fung Lai
- Department of Otorhinolaryngology, Head and Neck Surgery, Prince of Wales HospitalThe Chinese University of Hong KongHong KongChina
| | - Kit Ying Chan
- Department of Neurosurgery, Department of Surgery, Prince of Wales HospitalThe Chinese University of Hong KongHong KongChina
| | - Winnie Chiu Wing Chu
- Department of Imaging and Interventional Radiology, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
| | - Michael Chi Fai Tong
- Department of Otorhinolaryngology, Head and Neck Surgery, Prince of Wales HospitalThe Chinese University of Hong KongHong KongChina
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Sreelesh LS, Aswathi TV. Post dermoid excision nasal tip deformity correction using gelatin sponge. Indian J Otolaryngol Head Neck Surg 2022; 74:4831-4834. [PMID: 36742549 PMCID: PMC9895716 DOI: 10.1007/s12070-022-03118-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 06/28/2022] [Indexed: 02/07/2023] Open
Abstract
Reconstruction of the nasal tip after the excision of the dermoid cyst is difficult, especially if the size of the dermoid is large. Tip reconstruction using Interdomal sutures of alar cartilages and auricular cartilage graft has been used in such cases. We share a new method to manage the nasal tip defect following excision of nasal dermoid, using an absorbable gelatin sponge. A 13 years old female presented with a swelling tip of the nose for the past 2 years. The CT scan revealed a dermoid cyst at the tip of the nose over the alar cartilage with prominent buckling of the cartilages. The Dermoid cyst was excised through an open rhinoplasty incision. There was a defect of 2.2 cm diameter at the tip of the nose with deformed alar cartilages. A piece of absorbable gelatin sponge was folded, cut according to the shape of the cavity, and used to fill the cavity. The skin was draped over the cartilage and gelatin sponge. The post-operative period was uneventful. After 2 years of follow-up, the patient remained asymptomatic and satisfied with a nice contour of the nasal tip.
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Affiliation(s)
- L S Sreelesh
- Department of Plastic Surgery, Government Medical College, Kozhikode, Kerala India
| | - T V Aswathi
- Department of Dermatology, Malabar Medical College Hospital and Research Centre, Kozhikode, Kerala India
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杨 小, 唐 力, 王 蓬, 孙 记, 张 薇, 肖 潇, 韩 阳, 葛 文. [Clinical analysis of 59 cases of pediatric nasal dermal sinus cysts with midfacial infection as the first symptom]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:849-854. [PMID: 36347578 PMCID: PMC10127566 DOI: 10.13201/j.issn.2096-7993.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Indexed: 06/16/2023]
Abstract
Objective:To review the clinical and radiological presentation and management of infected nasal dermal sinus cysts(NDSC) in children. Methods:Clinical data were collected from 59 NDSC children with secondary fronto-orbital area infection who presented to Beijing Children's Hospital from January 2007 to December 2021. All patients underwent preoperative imaging workup, including MRI and CT. All patients underwent endoscopic excision of a NDSC under general anesthesia. Results:A total of 59 patients were included in the study,while 58 presented with a sinus, 1 presented with a cyst.The main lesions of NDSC included nasal root in 20 cases (33.9%), nasal bridge in 34 cases (57.6%), nasal tip in 4 cases (6.8%), and nasal tip and nasal root in 1 case (1.7%). The depth of lesions included 6 cases (10.2%) of superficial type of nasal frontal bone, 33 cases (55.9%) of nasal frontal bone, 19 cases (32.2%) of intracranial epidural type, and 1 case (1.7%) of intracranial epidural type. The main sites of infection included inner canthus in 15 cases (25.4%), nasal dorsum in 22 cases (37.3%), nasal root in 16 cases (27.1%), and forehead in 6 cases (10.2%). Among 59 cases, 7 cases (11.9%) were complicated with other diseases, and 4 cases(6.8%) had external nasal deformities. Surgical approaches included transverse incision in 12 cases(20.3%), minimal midline vertical incision in 41 cases (69.5%), external rhinoplasty in 4 cases (6.8%) and bicoronal incision with vertical incision in 2 cases (3.4%). The range of lesions was completely consistent with MRI results.All cases were successfully operated without one-stage nasal dorsum reconstruction. All patients were followed up from 7 to 173 months(average 52.2 months). There were 6 cases of recurrence, all of which were in situ recurrence. The operation was performed again, and no recurrence has occurred since the follow-up, No nasal deformity was noted, and cosmetic outcome were favorable for all patients. Conclusion:NDSC infection in children with midfacial infection as the first symptom is rare in clinical practice, and its manifestations are diverse. Early diagnosis and rational treatment are very important to improve the cure rate.Preoperative high resolution MRI combined with CT scanning is of great significance in judging the course of NDSC, especially the intracranial extension. The treatment goal is to achieve minimally invasive and individualized treatment under the premise of complete excision of the lesion, and take into account the cosmetic needs.
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Affiliation(s)
- 小健 杨
- 国家儿童医学中心 首都医科大学附属北京儿童医院耳鼻咽喉头颈外科(北京,100045)Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - 力行 唐
- 国家儿童医学中心 首都医科大学附属北京儿童医院耳鼻咽喉头颈外科(北京,100045)Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - 蓬鹏 王
- 国家儿童医学中心 首都医科大学附属北京儿童医院耳鼻咽喉头颈外科(北京,100045)Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - 记航 孙
- 国家儿童医学中心 首都医科大学附属北京儿童医院影像科Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health
| | - 薇 张
- 国家儿童医学中心 首都医科大学附属北京儿童医院耳鼻咽喉头颈外科(北京,100045)Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - 潇 肖
- 国家儿童医学中心 首都医科大学附属北京儿童医院耳鼻咽喉头颈外科(北京,100045)Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - 阳 韩
- 国家儿童医学中心 首都医科大学附属北京儿童医院耳鼻咽喉头颈外科(北京,100045)Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - 文彤 葛
- 国家儿童医学中心 首都医科大学附属北京儿童医院耳鼻咽喉头颈外科(北京,100045)Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
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10
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Kotowski M, Szydlowski J. Radiological diagnostics in nasal dermoids: Pitfalls, predictive values and literature analysis. Int J Pediatr Otorhinolaryngol 2021; 149:110842. [PMID: 34329830 DOI: 10.1016/j.ijporl.2021.110842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 07/10/2021] [Accepted: 07/16/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study aimed to present the accuracy of radiological diagnostics in pediatric patients with nasal dermoids and to discuss the potential factors influencing the radiological pitfalls on imaging in these cases. MATERIAL AND METHODS The patient's cohort included 25 surgically treated pediatric cases with nasal dermoid. The results of preoperative imaging studies were analyzed regarding intraoperative findings. A review of the literature concerning a series of cases with nasal dermoid was performed in order to evaluate the possible radiological pitfalls and the accuracy of radiological imaging. The following statistical parameters for the particular radiological tools was determined: sensitivity, specificity, predictive positive values and predictive negative values. RESULTS Total number of 18 CT and 14 MRI were performed. 6 out of 32 radiological examinations occurred to be inconsistent with operative findings. Potential pitfalls were identified and discussed. All the patients with false radiological results were below the age of 5 and 83% were below the age of 3 y.o. The overall sensitivity (S), specificity (SP), predictive positive value (PPV) and predictive negative value (PNV) for CT vs. MRI were 68% vs. 79%, 90% vs. 95%, 65% vs. 86% and 90% vs. 92%, respectively. CONCLUSIONS MRI technique characterizes with higher predictive values in terms of identifying intracranial extension of nasal dermoid on imaging. Further analysis of radiological methods' accuracy should be conducted based on the detailed data concerning age distribution. The combination of CT and MRI should become a gold standard in diagnostics of nasal dermoids in children under the age of 5.
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Affiliation(s)
- Michal Kotowski
- Department of Pediatric Otolaryngology, Poznan University of Medical Sciences, 27/33 Szpitalna Street, 60-572, Poznan, Poland.
| | - Jaroslaw Szydlowski
- Department of Pediatric Otolaryngology, Poznan University of Medical Sciences, 27/33 Szpitalna Street, 60-572, Poznan, Poland
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11
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Nasal Dermoids in Children: Factors Influencing the Distant Result. Indian J Otolaryngol Head Neck Surg 2021; 74:1412-1419. [DOI: 10.1007/s12070-021-02568-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022] Open
Abstract
AbstractThe aim of the study was to present a single institution’s treatment strategy for nasal dermoids and to identify factors influencing distant results. The study covered 24 surgically treated pediatric patients with nasal dermoids (NDs). The medical data concerning demographics, preoperative local inflammations and surgical procedures, form of the abnormality, imaging, surgical techniques, and a role of osteotomies and reconstructions were analyzed. The recurrence rates and distant aesthetic outcomes were assessed. The surgical approach included vertical incision in 21 patients, the external rhinoplasty approach in 2 cases, and bicoronal incision in 1 child. The intracranial extension was confirmed in 6 patients. Seven out of 8 cases with preoperative local inflammations and 3 out of 4 with secondary fistulization were < 4 years old. Nine patients required osteotomies. Three children required reconstruction of the nasal skeleton. None of the distant cosmetic results was described as hideous or unsatisfactory. The incidence of local inflammatory complications is unrelated to the age of the patients. The distant aesthetic result depends on both the initial extent of the disease and preoperative local conditions or interventions. Prompt surgical intervention is highly recommended.
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12
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Sommer F. Rare Diseases of the Nose, the Paranasal Sinuses, and the Anterior Skull Base. Laryngorhinootologie 2021; 100:S1-S44. [PMID: 34352902 PMCID: PMC8354577 DOI: 10.1055/a-1331-2469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Due to their low incidence and thus resulting limited diagnostic criteria as well as therapeutic options, rare diseases of the nose, the paranasal sinuses, and the anterior skull base are a significant challenge. The value as of which a disease has to be considered as rare amounts to a maximum of 5 patients per 10 000 people. Within these diseases, however, there are extreme differences. Some rare or orphan diseases like for example the inverted papilloma belong to regularly diagnosed and treated diseases of larger departments of oto-rhino-laryngology whereas other rare diseases and malformations have only been described in less than 100 case reports worldwide. This fact emphasizes the necessity of bundling the available experience of diagnostics and therapy. The present article gives an overview about rare diseases of the nose, the paranasal sinuses, and the anterior skull base from the field of diseases/syndromes of the olfactory system, malformations of the nose and paranasal sinuses, ventilation and functional disorders as well as benign and malignant tumors. The classification and data on diagnostic and therapeutic options were established based on the current literature.
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Affiliation(s)
- Fabian Sommer
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universitätsklinik Ulm
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Donnell CC, McKeague KF, Cooper A, Stenhouse J. Nasofrontal dermoid cyst: rare presentation of a philtrum sinus. Br J Oral Maxillofac Surg 2020; 58:608-610. [PMID: 32201047 DOI: 10.1016/j.bjoms.2020.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 03/02/2020] [Indexed: 11/28/2022]
Abstract
Congenital midline nasal lesions are extremely rare, and nasal dermoids are their most common presentation. To the best of our knowledge, only two cases of a philtrum sinus with skull base extension have been reported previously. A 3-year-old boy presented to the maxillofacial department with a discharging upper lip sinus that had been present from birth. No other congenital abnormalities were reported. Initially this sinus was assumed to be blind-ended and excised under general anaesthetic, but the area then failed to heal. Radiological work-up showed a patent dermal sinus that extended from the infranasal region through the nasal septum into the basal aspect of the anterior cranial fossa. The patient was referred for multidisciplinary management. A high index of suspicion of nasofrontal dermoid should be exercised when a patient presents with an upper lip sinus and recurrent discharge, until it is proven otherwise.
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Affiliation(s)
| | - Kelly F McKeague
- School of Dentistry, Belfast Health and Social Care Trust, United Kingdom
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Wales J, Alinasab B, Fridman-Bengtsson O. A superficial nasal dermoid cyst excised through a novel horizontal zig-zag incision in a 49-year-old man. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2020. [DOI: 10.1080/23772484.2020.1733427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Jeremy Wales
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Babak Alinasab
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Ola Fridman-Bengtsson
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
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Hidalgo J, Redett RJ, Soares BP, Cohen AR. Meet in the middle: a technique for resecting nasocranial dermoids-technical note and review of the literature. Childs Nerv Syst 2020; 36:477-484. [PMID: 31925508 DOI: 10.1007/s00381-020-04499-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/02/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Nasal dermoids with intracranial extension are benign lesions that can have life-threatening consequences, as a nasal punctum may serve as a portal of entry for infection into the central nervous system. The surgical management of these lesions can be challenging, as the extracranial and intracranial cysts and sinus tract must be resected to prevent recurrence, and the surgery must be carried out with an acceptable esthetic result. TECHNIQUE The authors present a technique for the resection of nasocranial dermoids that eliminates the need to remove and replace the frontonasal segment. Working through a small frontal craniotomy enables the surgeon to drill out the sinus tract through the foramen cecum and inferiorly into the nose. This exposure eliminates the need to enter the frontal sinus, if it is present. CONCLUSION The extracranial punctum and tract are resected from below in a minimally invasive fashion that permits removal of the lesion without a disfiguring scar.
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Affiliation(s)
- Joaquin Hidalgo
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard J Redett
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bruno P Soares
- Department of Radiology, University of Vermont Medical Center, Burlington, VT, USA
| | - Alan R Cohen
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Meher R, Jain A, Singh I, Singh N, Sharma R. Paediatric nasal dermoids: Our experience. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020. [DOI: 10.1016/j.otoeng.2018.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hosokawa T, Takahashi H, Miyasaka Y, Ohira K, Tanami Y, Sato Y, Ishimaru T, Kawashima H, Hosokawa M, Oguma E, Yamada Y. Ultrasound Evaluation of Dermal Sinuses/Fistulas in Pediatric Patients. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3107-3122. [PMID: 31063247 DOI: 10.1002/jum.15016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/01/2019] [Accepted: 04/10/2019] [Indexed: 06/09/2023]
Abstract
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.
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Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroaki Takahashi
- Department of Diagnostic and Interventional Radiology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yusuke Miyasaka
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Kenji Ohira
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yumiko Sato
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Tetsuya Ishimaru
- Department of Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Kawashima
- Department of Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Mayumi Hosokawa
- Department of Pediatrics, Saitama City Hospital, Saitama, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
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Meher R, Jain A, Singh I, Singh N, Sharma R. Paediatric nasal dermoids: Our experience. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019; 71:26-31. [PMID: 31029379 DOI: 10.1016/j.otorri.2018.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/23/2018] [Accepted: 12/05/2018] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Nasal dermoids are rare developmental anomalies seen in children. This study reports our experience in a developing country of the clinical and radiological findings as well as the management of nasal dermoids. METHODS A retrospective analysis was performed, from 2012 to 2017, for 10 patients admitted for the treatment of nasal dermoids at a tertiary care center. The clinical presentation, preoperative imaging (CT/MRI), surgical approach, intraoperative findings, complications and recurrence were reviewed. RESULTS Ten patients were included in this study, 6 males and 4 females, with an average age of 10.2 years at the time of presentation. Three patients presented with a mass located on the nasal dorsum, 1 had a nasoglabellar mass, 2 patients had a mass located on the nasal dorsum with visible sinus, and 4 patients presented with a sinus on the nasal dorsum, in which 1 patient had a tuft of hair. CT was performed in all the cases. It was not suggestive of intracranial extension in 9 patients, and was non-diagnostic in one patient. Both CT and MRI were performed on 2 patients, with no evidence of intracranial extension. Surgical and radiological findings were concordant in 8 patients (80%). CONCLUSION Nasal dermoids require preoperative imaging and precise surgical planning to achieve complete removal.
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Affiliation(s)
- Ravi Meher
- Department of ENT, MAMC, New Delhi, India
| | - Avani Jain
- Department of ENT, MAMC, New Delhi, India.
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Brady S, Bell E, Courtman N, Chevoir ML. Nasal dermoid cyst with intracranial extension in a cat. JFMS Open Rep 2019; 5:2055116919827404. [PMID: 30792875 PMCID: PMC6376515 DOI: 10.1177/2055116919827404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Case summary An 11-month-old female neutered Ragdoll cat was presented for focal seizures, aggression and altered behaviour. A diagnosis of a nasal dermoid cyst with intracranial extension was made following MRI, cytology and histopathology. The cyst was surgically excised with a resolution of clinical signs, with the exception of ongoing seizure activity requiring anti-seizure medication. Relevance and novel information To our knowledge, this is the first reported case of a nasal dermoid cyst in a cat, and the first reported case in the veterinary literature of any species with a nasal dermoid cyst presenting with neurological signs.
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Affiliation(s)
- Stacey Brady
- Department of Neurology, University of Melbourne Veterinary Teaching Hospital, Melbourne, Australia
| | - Erin Bell
- Department of Internal Medicine, Sydney Veterinary Emergency & Specialists, Sydney, Australia
| | - Natalie Courtman
- Department of Clinical Pathology, University of Melbourne, Melbourne, Australia
| | - Matthias Le Chevoir
- Department of Neurology, University of Melbourne Veterinary Teaching Hospital, Melbourne, Australia
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Masses of developmental and genetic origin affecting the paediatric craniofacial skeleton. Insights Imaging 2018; 9:571-589. [PMID: 29766474 PMCID: PMC6108962 DOI: 10.1007/s13244-018-0623-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/26/2018] [Accepted: 03/19/2018] [Indexed: 01/05/2023] Open
Abstract
Although rare, masses and mass-like lesions of developmental and genetic origin may affect the paediatric craniofacial skeleton. They represent a major challenge in clinical practice because they can lead to functional impairment, facial deformation and disfigurement. The most common lesions include fibrous dysplasia, dermoid cysts, vascular malformations and plexiform neurofibromas. Less common lesions include torus mandibularis and torus palatinus, cherubism, nevoid basal cell carcinoma syndrome, meningoencephalocele and nasal sinus tract. This article provides a comprehensive approach for the evaluation of children with masses or mass-like lesions of developmental and genetic origin affecting the craniofacial skeleton. Typical findings are illustrated and the respective roles of computed tomography (CT), cone beam CT (CBCT), magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) sequences and ultrasonography (US) are discussed for the pre-therapeutic assessment, complex treatment planning and post-treatment surveillance. Key imaging findings and characteristic clinical manifestations are reviewed. Pitfalls of image interpretation are addressed and how to avoid them. TEACHING POINTS: • Masses of developmental and genetic origin may severely impair the craniofacial skeleton. • Although rare, these lesions have characteristic imaging features. • CT, MRI and ultrasonography play a key role in their work-up. • Recognition of pivotal imaging pearls and diagnostic pitfalls avoids interpretation errors.
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Infected Nasal Dermoid Cyst/Sinus Tract Presenting With Bilateral Subperiosteal Supraorbital Abscesses: The Midline Nasal Tuft of Hair, an Overlooked Finding. Ophthalmic Plast Reconstr Surg 2018; 34:e31-e34. [PMID: 29068832 DOI: 10.1097/iop.0000000000001000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This case is, to the authors' knowledge, the first reported case in the literature of bilateral orbital abscesses as result of an infected nasal dermoid. The baby presented with what proved to be bilateral supraorbital subperiosteal abscesses with associated frontal osteitis/osteomyelitis and soft tissue infection of the glabella. Methicillin-sensitive staphylococcus aureus infection was found in the setting of a midline nasal dermoid with tuft of hair and infected sinus tract that was at least initially missed on diagnosis.
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Sparing a Craniotomy: The Role of Intraoperative Methylene Blue in Management of Midline Dermoid Cysts. Plast Reconstr Surg 2017; 139:1445-1451. [PMID: 28538574 DOI: 10.1097/prs.0000000000003369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Midline nasal dermoid cysts are rare congenital anomalies that extend intracranially in approximately 10 percent of cases. Cysts with intracranial extension require a craniotomy to avoid long-term complications, including meningitis, abscesses, and cavernous sinus thrombosis. Current guidelines recommend preoperative imaging with either magnetic resonance imaging or computed tomography to determine appropriate management. METHODS Patients who underwent excision of a midline nasal dermoid cyst between January 1995 and September 2016 were identified using Current Procedural Terminology codes. In cases with equivocal imaging findings or uncertain stalk extent during surgical dissection, methylene blue was used intraoperatively. Demographics, preoperative imaging findings, intraoperative dye findings, surgical approach, and complications were collected. RESULTS A total of 66 midline dermoid cyst excisions were identified; 17 (25.8 percent) had intracranial extension requiring craniotomy. Preoperative imaging showed a subcutaneous cyst in 41 (62.1 percent), intraosseous tracking in three (4.5 percent), and intracranial extension in 15 (22.7 percent). Twelve patients (18.2 percent) had preoperative imaging that was inconsistent with intraoperative findings. Methylene blue was used in 17 cases and indigo carmine was used in one case. Intraoperative dye findings changed management in five cases, and in three cases a craniotomy was avoided without evidence of cyst recurrence. CONCLUSIONS This report is the largest published series of midline dermoid cysts with intracranial extension. In almost 20 percent of cases, preoperative imaging was not consistent with intraoperative findings. Given disparate radiographic and intraoperative findings, methylene blue is a valuable tool that can facilitate appropriate, morbidity-sparing management of midline dermoid cysts. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Management of midline nasal dermoid lesions in children by external rhinoplasty. J Taibah Univ Med Sci 2017; 12:324-328. [PMID: 31435258 PMCID: PMC6695084 DOI: 10.1016/j.jtumed.2017.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/03/2017] [Accepted: 02/06/2017] [Indexed: 11/30/2022] Open
Abstract
Objectives Nasal dermoid cysts are rare congenital lesions of ectodermal and mesodermal origin. Treatment of these cysts entails complete surgical excision, and several surgical incisions have been advocated. We present our experience utilizing an external rhinoplasty approach in seven children with nasal dermoid cysts and fistulae. Methods A prospective study of 7 cases of nasal dermoid cysts and sinuses, diagnosed clinically and radiologically, were successfully treated by an external rhinoplasty approach in two teaching hospitals during the period of Apr 2011 to Nov 2013. Post operatively, an average follow-up of 12 months was observed by clinical examination, and the outcomes were documented and analysed. Results Seven children, 5 girls (71%) and 2 boys (29%), with ages ranging from 1.5 years to 16 years, who had nasal dermoid cysts and/or sinuses were successfully excised via an external rhinoplasty approach. The clinical presentation included midline facial swelling in five patients, a midline sinus in one patient and a dorsal midline nasal pit in one patient. No accessory tracts were found in these seven cases. Complete excision was achieved in 6 patients. There was one recurrence after 6 months with a successful complete resection with revision external rhinoplasty. All patients were followed up for an average of one year post operatively. Conclusion The external rhinoplasty approach is an effective surgical approach in treating paediatric nasal dermoid cysts and sinuses with a very low incidence of recurrence.
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