[Nasal dermal sinus in children: a review based on a series of 6 cases]

Nasal Dermoid Cyst: A Case Report

A dermoid cyst (DC) is a rare, benign congenital skin lesion that can occur anywhere on the skin and take any shape. DC is clinically diagnosed through imaging and biopsy. The usual treatment of choice for DC is surgical excision to prevent any local complications, such as inflammation, infection, and bone resorption. The type of surgery depends on the size, location, and extension of the cyst. When the cyst presents in certain areas, such as the nose, face, and scalp, surgery can be difficult owing to the possibility of an intracranial connection. Therefore, imaging is usually performed before intervening surgically. Here, we present the case of a two-year-old boy with no medical or surgical history who presented to our dermatology clinic with a slow-growing mass on his nose. During the consultation, the mass was examined, a complete medical history was obtained, and the patient was advised to undergo imaging, which revealed that the mass was a DC. Nevertheless, no deep connection was observed on imaging, and the mass was surgically removed without any complications.

Meet in the middle: a technique for resecting nasocranial dermoids-technical note and review of the literature

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.

Infected Nasal Dermoid Cyst/Sinus Tract Presenting With Bilateral Subperiosteal Supraorbital Abscesses: The Midline Nasal Tuft of Hair, an Overlooked Finding

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.

Safe and sustainable: the extracranial approach toward frontoethmoidal meningoencephalocele repair

OBJECTIVE Although rare, frontoethmoidal meningoencephaloceles continue to pose a challenge to neurosurgeons and plastic reconstructive surgeons. Especially when faced with limited infrastructure and resources, establishing reliable and safe surgical techniques is of paramount importance. The authors present a case series in order to evaluate a previously proposed concise approach for meningoencephalocele repair, with a focus on sustainability of internationally driven surgical efforts. METHODS Between 2001 and 2016, a total of 246 patients with frontoethmoidal meningoencephaloceles were treated using a 1-stage extracranial approach by a single surgeon in the Department of Neurosurgery of the Yangon General Hospital in Yangon, Myanmar, initially assisted by European surgeons. Outcomes and complications were evaluated. RESULTS A total of 246 patients (138 male and 108 female) were treated. Their ages ranged from 75 days to 32 years (median 8 years). The duration of follow-up ranged between 4 weeks and 16 years (median 4 months). Eighteen patients (7.3%) showed signs of increased intracranial pressure postoperatively, and early CSF rhinorrhea was observed in 27 patients (11%), with 5 (2%) of them requiring operative dural repair. In 8 patients, a decompressive lumbar puncture was performed. There were 8 postoperative deaths (3.3%) due to meningitis. In 15 patients (6.1%), recurrent herniation of brain tissue was observed; this herniation led to blindness in 1 case. The remaining patients all showed good to very good aesthetic and functional results. CONCLUSIONS A minimally invasive, purely extracranial approach to frontoethmoidal meningoencephalocele repair may serve well, especially in middle- and low-income countries. This case series points out how the frequently critiqued lack of sustainability in the field of humanitarian surgical missions, as well as the often-cited missing aftercare and dependence on foreign supporters, can be circumvented by meticulous training of local surgeons.

Surgery of Anterior Skull Base Lesions in Children

INTRODUCTION

Lesions affecting the anterior skull base represent a rare group of craniofacial pathologies. A tumor of the facial midline, meningitis, or rhinoliquorrhea may be indicative of malformations like dermoid cysts, gliomas, encephaloceles, or nasal fistulas.

METHODS

We present a case series of 13 children (4 months to 12 years; 8 males, 5 females) with lesions involving the anterior skull base, which were treated surgically in an interdisciplinary setting. This case series includes cases of nasal fistulae (n = 5), nasal cysts (n = 5), aneurysmal bone cyst, nasal glioma, and meningoencephalocele (n = 1).

RESULTS

All lesions were resected with a transnasal, transcutaneous, and/or transcranial approach with reconstruction of the anterior skull base if intracranial/intradural extension was detected. In 5 cases, a dura leakage was visible, which was sealed via Onlay-technique in 3 cases, whereas in 2 cases involving a greater dural defect, the GAP-CAS technique was performed. No complications occurred, and no recurrence was visible in a long-term follow-up. An algorithm for a systematic approach to these various pathologies is provided.

CONCLUSION

Congenital pathologies of the anterior skull base are rare, challenging to diagnose, and present as clinical emergencies. An interdisciplinary surgical approach is needed for best functional and aesthetic results.

Paired discharging sinuses at medial canthus of left eye and dorsum of nose in a 2-year toddler since birth associated with interfalcial dermoid

Twin nasal dermal sinus with associated intracranial dermoid located in interfalcial region is a very rare occurrence and is reported only in the occipital and temporal regions. However, multiple sinuses located in the canthus and dorsum of nose are not reported till date. Authors report an interesting first case of interfalcial dermoid cyst associated with twin discharging dermal sinuses, who underwent successful surgical repair in the world literature. The authors report the management of an unusual case and the review has been discussed briefly.