Craniofacial dermoids: an embryological theory unifying nasal dermoid sinus cysts

Vertical dorsal rhinotomy in pediatric nasal dermoid surgery

INTRODUCTION AND OBJECTIVES

Nasal dermoids are uncommon midline congenital lesions in the nose, usually diagnosed in the first years of life. Imaging is mandatory to evaluate local and intracranial extension and treatment consists in surgical excision. This study aims to review the experience of the department in managing pediatric nasal dermoids using a dorsal rhinotomy surgical approach.

MATERIAL AND METHODS

Retrospective case series of pediatric nasal dermoids treated at a tertiary university teaching hospital over a period of seven years.

RESULTS

Nine children were treated during this period. Clinical presentation was a dermoid sinus-cyst in seven cases and a cystic lesion in two. Pre-operative imaging revealed extension of the lesion to the foramen cecum in three cases. Surgery was performed via vertical dorsal rhinotomy in all patients, and associated endoscopic surgery was used in three patients. Reconstruction with autologous material was performed in three cases. No complications or recurrences were registered during the follow-up.

CONCLUSIONS

In the presented series, a vertical dorsal rhinotomy incision has provided good functional and aesthetic results. The possibility of nasal dermoid intracranial extension should be accessed with imaging but remains uncommon. In its absence, this approach may be useful and can be paired with other techniques, such as nasal endoscopy, to achieve the best outcomes.

Ultrasound as a standalone tool for the management of pediatric calvarial dermoid cysts

PURPOSE

Calvarial dermoid and epidermoid cysts are benign lesions common in pediatric neurosurgery. Diagnosis is primarily clinical, with frequent but inconsistent use of imaging. Dermoids have been shown to possess distinct sonographic features, but ultrasound (US) remains underutilized in their management. The purpose of this study is to investigate the independent reliability of US in managing pediatric calvarial dermoids and distinguishing them from other calvarial lesions.

METHODS

A retrospective review of consecutive patients ≤ 21 years of age with surgically resected calvarial masses between 2017-2024 was performed. Demographic, clinical, and imaging data were analyzed. Pearson chi-squared tests were used for comparison of categorical variables and a binomial linear model was generated controlling for age, lesion tenderness, growth, and suture location.

RESULTS

Fifty-nine patients with 61 lesions (31 in females; median age 13 months) were included. Dermoids were more common in younger patients (median age 12 months), along suture lines, and were less likely to present with tenderness (p < 0.001) or rapid growth (p = 0.003). Ultrasound was used in 83% of cases and was the sole imaging modality in 33%. On multivariate analysis, suture location was a significant positive predictor of a dermoid diagnosis (OR = 8.08, 95% CI = 1.67-44.18), while rapid growth was a significant negative predictor (OR = 0.08, 95% CI = 0.003-0.80).

CONCLUSION

Ultrasound presents a sensitive and reliable method for the evaluation of most pediatric calvarial lesions, especially dermoid cysts, and warrants being part of standard workup. With appropriate patient selection, US obviates the need for additional imaging in pediatric patients.

[Main Types of Cysts in Dermatopathology: Part 1]

Cystic structures represent one of the most common findings in dermatopathology. These encompass both cystic tumors and pseudocysts resulting from the accumulation of certain substances, such as mucin. In a two-part series (of which this is the first part), we have reviewed the principal types of cysts and pseudocysts that may be observed in cutaneous biopsies, examining their histopathological features and primary differential diagnoses. This first part encompasses infundibular cysts, eruptive dermoid cysts, pigmented follicular cysts, pilonidal cysts, tricholemmal cysts, milium cysts, hybrid cysts, bronchogenic cysts, as well as steatocystoma, hydrocystoma, and comedones.

Spontaneous recovery of underlying bony erosion following surgical removal of craniofacial dermoid cysts in periatric patients: A prospective study

This study aimed to evaluate the spontaneous recovery of bone deformity after surgical excision of craniofacial dermoid cysts in pediatrics. Pediatric patients who underwent excision of a dermoid cyst were included in the study. A prospective analysis was conducted to evaluate the amount of bone recovery by comparing the depth of bony concavity in the preoperative and postoperative (6 months) ultrasonography. In 145 of 187 patients with preoperative imaging available, the mean size of dermoid cysts was 1.4 cm3 (range, 0.1 to 9.5), and 41.4% (60/145 cases) showed cranial bone depression. In the comparison of preoperative and postoperative ultrasonography of 30 patients, the mean depth of bony cavity decreased significantly from 4.0 to 0.9 mm (p<0.001) after a mean of 6.7 months postoperatively. There was 13.3% (4/30) of mild (≤2.0 mm), 40.0% (12/30) of moderate (>2.0 to ≤4.0 mm), and 46.7% (14/30) of severe (>4.0 mm) depression, and the concavity depth significantly decreased in all groups (p = 0.028, mild; p<0.001, moderate; p<0.001 severe). Within the limitations of the study it seems that significant recovery of cranial bone depression does take place within 6 months after excision of craniofacial dermoid cysts in pediatric patients, saving the need for immediate reconstruction.

Congenital midline upper lip sinuses with intracranial extension - A variant of nasal dermoid? An embryology-based concept

OBJECTIVE

The study aimed to present the comparative analysis of midline congenital upper lip sinuses (MCULS) and nasal dermoids (NDs). The clinical similarity of congenital midline pathologies of the midface was interesting subject for further studies. Therefore, histopathological, and embryological background were also analyzed to verify a hypothesis that NDs and MCULSs are the different variants of the same entity.

MATERIAL AND METHODS

The study group included 27 surgically treated pediatric cases with the congenital midline sinus of the nose (n = 25) or upper lip (n = 2). Seven children presented intraoperatively confirmed intracranial extension of the abnormality, 6 in NDs group and 1 in MCULS group. Apart from clinical characteristics also histopathological results were compared in both groups. An analysis of the literature concerning the proposed theories of origin of NDs as well as the current classification systems of MCULSs and NDs were conducted.

RESULTS

The analysis revealed that MCULSs present the same clinical characteristics as NDs. No differences were noticed in the histopathological results. The embryological theories presented so far are insufficient to convincingly explain the precise process of origin of abnormalities such as ND and MCULS. Nevertheless, the developmental embryological processes of the midface shed a new light on the common origin of NDs and MCULSs. The proposal of an update of the existing classification of midline congenital midface sinuses was presented.

CONCLUSIONS

The comparative analysis of clinical, histopathological, and embryological characteristics confirms that NDs and MCULSs are different forms of the same entity. Embryological implications result in the possibility of intracranial extension in each case of MCULS. Therefore, CT and MR imaging which provide irreplaceable information are recommended for all patients with MCULS. The updated classification of midline congenital midface sinuses should be taken into consideration.

Anterior Fontanelle Dermoid Cyst: Surgical Technique

Dermoid cysts are benign congenital lesions that usually appear on the surface of the skull, mainly on the anterior fontanelle. Diagnosis is usually made in the first months of life by physical examination and imaging studies such as CT, MRI, or ultra sound (US) Doppler. It is important to distinguish it from other similar lesions that represent greater surgical complexity, morbidity, and mortality. In this work, we show the principle differential diagnoses, the diagnostic approach, and the surgical technique used in the resection of the dermoid cyst located over the anterior fontanelle.

Ultrasonographic findings of pediatric dermoid cyst

BACKGROUND

The precise diagnosis of dermoid cysts, which are usually located deeper than other common cysts, is important because dermoid cysts occasionally recur after incomplete excision. Ultrasonography (US) could give useful preoperative information of dermoid cysts but only a few studies have been conducted on US findings related to dermoid cysts. This study aimed to investigate clinical and US findings on pediatric dermoid cysts.

METHODS

We retrospectively reviewed the medical records, clinical photographs, and US findings of 31 pediatric patients (≤18 years of age) with histopathologically diagnosed dermoid cysts who visited the Pusan National University Hospital between 2007 and 2016.

RESULTS

Of the 31 patients, 25 underwent ultrasonography. The mean long diameter, short diameter, and depth of the cysts were 12.7, 9.0, and 3.8 mm, respectively. Sixteen cysts (64%) were ovoid, 23 (92%) showed hypoechogenicity, 20 (80%) showed heterogeneity, 19 (76%) showed well-demarcated outer margins, and all cysts showed positive posterior acoustic enhancement. All cysts extended to the subcutaneous tissue, and 15 (60%) showed a connection with the underlying muscle.

CONCLUSIONS

Ultrasonography may be a useful diagnostic method to visualize the extent and location of the dermoid cyst and make an accurate diagnosis prior to surgical intervention.

Broad, Recurrent Nasal Dermoid Cyst: A Challenging Task

Nasal dermoid sinus cyst is a rare congenital midline anomaly. The embryological origin is different from the dermoid cysts seen in other parts of the face. Nasal dermoid sinus cysts constitute 1% to 3% of all dermoid cysts and 11% to 12% of head and neck dermoid cysts. While most lesions are detected in the first 3 years, in some cases they may not be noticed until later years. Delay in diagnosis increases recurrent infections, airway obstruction and intracranial complications. The authors present a 34-year-old patient with a broad nasal dermoid cyst who had previously undergone external rhinoplasty for a nasal dermoid cyst but relapsed after 5 months.

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

Introduction

Nasal 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.

Aim

To demonstrate the clinical, radiological and diagnostic pitfalls of NDSCs affecting the frontal sinus.

Material and methods

A retrospective analysis of NDSCs affecting the frontal sinus with a literature review and a novel classification is presented.

Results

We 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.

Conclusions

NDSCs 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.

Dermoid and Epidermoid Cysts of Scalp: Case Series of 234 Consecutive Patients

BACKGROUND

Dermoid and epidermoid cysts are among the most frequent lesions of the scalp in the pediatric population. Optimal management of a suspected dermoid or epidermoid cyst in children is debated: Some authors advocate conservative management on the basis of the benign histology of these entities, while others prefer surgical excision.

OBJECTIVE

Our objective is to demonstrate that excision of dermoid and epidermoid cysts is a safe procedure and that early surgery is effective in preventing potential complications related to cyst growth.

METHODS

We retrospectively collected data on patients who underwent surgery for excision of proven dermoid or epidermoid cysts between January 2006 and October 2017.

RESULTS

In 234 patients, 237 cysts were excised. Mean age at presentation was 26.99 ± 32.7 months; 48.7% of patients were operated on between 1 and 3 years of age, and 32.9% were younger than 1 year of age. Cysts were more frequently located in the frontal bone than in occipital and supraorbital regions. In 36.28% of cases there was no significant cranial impingement, while 21.94% of the cysts eroded through a partial thickness of the cranium, 12.23% were in the full thickness of the skull, and 0.84% had epidural extension. We identified 22 intradiploic cysts. Statistical analysis demonstrated significant association between frontal and pterional localization and bone erosion. Neither major complications nor cyst recurrence were observed.

CONCLUSIONS

Excision of dermoid and epidermoid cysts is a safe procedure for neurosurgeons dealing with this disease, even in young patients. Early resection is recommended due to the potential adverse effects that may occur if these cysts are left untreated.

The Appropriate Surgical Approach to Frontotemporal Dermoid Cysts in Adult Patients

Because frontotemporal dermoid cysts are superficial masses on the zygomaticofrontal suture, they are usually removed by simple direct excision in pediatric patients. Adult patients, however, require a more involved treatment approach because these cysts may be large and extend deeply into the surrounding tissue. From 2008 to 2015, 33 adult patients with frontotemporal dermoid cysts were treated in our clinic under a new treatment algorithm. Patients with a cyst smaller than 2 cm in diameter were treated using a direct excisional approach without a preoperative computed tomography (CT) evaluation. Patients with a cyst larger than 2 cm in diameter underwent a preoperative CT evaluation to determine the exact location of the cyst. If the cyst invaded the temporal fossa, a hemicoronal approach was used for excision. Cysts that did not cross the lateral orbital rim were removed using a direct excisional approach. Among the 33 patients in the study, 6 patients had cysts smaller than 2 cm in diameter, and 27 patients had cysts larger than 2 cm in diameter. Of the 27 patients with large dermoid cysts, 17 cysts showed temporal fossa invasion and 10 showed no signs of temporal fossa invasion. In all cases, the cyst was completely excised without rupture, and no instances of complications or recurrence were observed. In adults with frontotemporal dermoid cysts larger than 2 cm in diameter, preoperative CT evaluations should be performed. If the evidence suggests that a cyst has invaded the temporal fossa, a hemicoronal approach is required for complete excision.

Considerations in the management of congenital cranial dermoid cysts

OBJECTIVE Congenital dermoid cysts (CDCs) develop from the entrapment of the surface ectoderm along the lines of embryonic fusion and have a capacity to grow. Given this capacity for continual expansion, the timing of removal and anticipation of possible epidural extension is important. METHODS The authors retrospectively reviewed records of patients with the diagnosis of dermoid cyst presenting over a period of 10 years. Baseline characteristics, histological reports, and surgical records were collected and analyzed. Only those patients with histological confirmation of dermoid cyst were included in the study. RESULTS One hundred fifty-nine (64 male and 95 female) patients were studied. The average age at the time of surgery ranged from 1 month to 63 years (mean 3.55 ± 9.58 years, median 11 months). Eighteen (11.3%) CDCs were in the midline anterior fontanelle, 52 (32.7%) were frontozygomatic, 14 (8.8%) occurred along the coronal sutures, and 75 (47.2%) occurred along the lambdoid sutures. In 74 (46.5%) cases the cysts were found to insignificantly erode the cranium, 30 (18.9%) eroded through a partial thickness of the cranium, 47 (29.6%) eroded through the full thickness of the cranium, and 8 (5.0%) eroded through the full thickness of the cranium and demonstrated epidural extension. The study population showed female predominance (n = 95, 59.7%). Although cyst location and patient sex were not found to vary significantly with cranial involvement (p = 0.196 and p = 0.066, respectively), delay in time to surgery did vary significantly (p < 0.00001). CONCLUSIONS Congenital cranial dermoid cysts found in infants and children are best removed early.

Intracranial Nasal Dermoid Sinus Cyst: Transnasal Endoscopic Resection by Open Rhinoplasty Approach, With Intraoperative Video

Nasal dermoid sinus cysts are rare congenital lesions that may lead to recurrent soft tissue infections and severe intracranial complications. In case of an intracranial extension, the traditional surgical approach includes a frontal craniotomy with significant morbidity. As a less invasive alternative, a transnasal endoscopic approach has been recommended.This report describes the transnasal endoscopic resection of an intracranial nasal dermoid sinus cyst via an open rhinoplasty approach, which achieved a wide surgical exposure with minimal invasivity and ideal aesthetic results. An intraoperative video demonstrates this combination of techniques in this rare skull base/intracranial pathology.

Median philtrum sinus: a rare presentation and review of management options

Nasal dermoids are rare congenital abnormalities, and there is only one previously reported case of a philtrum sinus tract extending to the skull base. A 2-month-old boy was presented with an incidental finding of a median philtrum sinus with no infective features and no other abnormal clinical findings. MRI demonstrated a sinus tract extending from the philtrum to the crista galli. On multidisciplinary review, a conservative approach was taken due to the asymptomatic nature of the patient. Given the rarity of nasal dermoids, diagnosis requires precise clinical examination and MRI to identify the extent of the tract. Management options require a multidisciplinary case-specific approach and include non-surgical as well as surgical approaches.

[Congenital cysts and fistulae in children]

Cysts and fistulae of the face and neck in children are formed before birth and correspond to the persistence of embryonic remnants that occur due to coalescence defects of embryonic buds or due to epidermal inclusion. They represent the most common pathological malformation of the face and neck. They may be separated according to their location into laterocervical cysts and fistulas or median cysts and fistulas. Their discovery may occur prematurely at birth or later during growth or in adulthood. Their treatment always requires surgical excision, which must be complete in order to prevent recurrences.

The management of midline frontonasal dermoids: a review of 55 cases at a tertiary referral center and a protocol for treatment

BACKGROUND

The incidence of midline frontonasal dermoid cysts is one in 20,000 to one in 40,000. These lesions may have intracranial extension. This is explained by the anatomy and embryology of nasofrontal development. Skin involvement may also be extensive. Incomplete excision frequently leads to recurrence. The authors report their experience and pathway for management of midline dermoids.

METHODS

Databases were searched to identify patients who had undergone surgery for removal of a dermoid cyst. Preoperative imaging and indications for surgery were reviewed. Cases were grouped according to surgical approach, and outcomes and complications were identified.

RESULTS

Fifty-five patients were treated. Magnetic resonance imaging or computed tomography was used to delineate the anatomy, and surgical excision was expedited if there was a history of infection, especially if imaging suggested intracranial extension. Twelve patients were treated endoscopically (one was converted to open). Eleven required transcranial approaches for intracranial extension (20 percent). Of these, one lesion breached the dura. The remaining 32 patients had dermoids excised with an open approach (direct, bicoronal, or rhinoplasty). There were no recurrences in the open group and there was one recurrence in the transcranial group. This was treated by reexcision.

CONCLUSION

Midline dermoid cysts are relatively uncommon. However, knowledge of the pathogenesis of these lesions together with the authors' experience over 15 years has allowed them to develop a protocol-driven approach, with a low incidence of complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

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

INTRODUCTION

Nasal dermal sinus in children (NDSC) is a rare malformation (1/20,000 to 1/40,000). Apart from local infection, they present as median nasal lump or pit on the dorsum and their diagnosis and treatment are often delayed. Consequences of untreated NDSC are: local infection, meningitis, and empyema, due to their frequent intracranial extension.

PATIENTS AND METHODS

Six cases of NDSC were retrospectively reviewed (5 boys and one girl), all treated between 2006 and 2012 in our institution (Nancy University Hospital). All patients underwent a brain and facial CT-scan and MR imaging to check any bony lesions, skull base extension by foramen cæcum, course of the sinus and the possible associated brain malformations. Evolution, treatment and follow-up (FU) were conducted by the same multidisciplinary team (neurosurgeon, ENT surgeon, and plastic surgeon). Children were operated on by a conjoined approach (cranial and facial) for removal of the sinus and its intracranial extension.

RESULTS

Mean age at diagnosis was 12 months (birth-36 months). Initial presentation consisted of three local infections, one dorsum nasal lump, one CSF leakage, and one asymptomatic child. Five children presented with a skull base extension. There were no associated brain malformations. We observed only one surgical complication (bleeding from the anterior part of the superior sagittal sinus during dissection) leading to blood transfusion. Pathology results confirmed three dermoid cysts, one epidermoid cyst, one cyst with granulation tissue, and negative in one case. Average FU was 30.8 months (4-84 months). Two recurrences (same child) occurred, leading to two re-operations. There were no recurrences or complications at the end of FU.

CONCLUSION

NDSC are rare malformations, mostly diagnosed before the age of three years, due to an infectious complication. The aim of the treatment is complete removal to avoid recurrence, and a multidisciplinary strategy is required.

Dermoid cysts: a report of 75 pediatric patients

Dermoid cysts (DCs) are benign cutaneous tumors that tend to persist and grow. The aim of this study was to examine the clinicopathologic features of congenital DCs. We present a case series of 75 children with a clinicopathologic diagnosis of DC. Seventy-two cysts were located on the head, one on the neck, and two on the trunk. Six cysts were located along the midline. Eight patients had symptoms other than changes in cyst size. Imaging studies were performed on 15 patients. Surgical excision was the primary treatment in all 75 cases. Neurosurgery and ophthalmology services were involved in the care of some patients. Histopathologic studies reported a foreign body giant cell reaction in 17 of the cysts. No recurrence was documented. DCs can remain stable for years, but they can become symptomatic as a result of enlargement and rupture or, more rarely, as a result of extension into surrounding tissues. Physicians should be aware that certain locations have a higher risk of DC extension, and adequate diagnostic investigations should be performed before their complete resection.

Inheritance of nasal dermoid sinus cyst and evidence for association with third ventricle colloid cyst

PURPOSE

The purpose of this paper is to study the possible inheritance of nasal dermoid sinus cyst in the Finnish population.

METHODS

A patient questionnaire and interview were utilized for this study.

RESULTS

We identified nine patients with dermoid sinus cyst. Only one of them had familial nasal dermoid sinus cyst. We found no evidence for founder effect.

CONCLUSIONS

We report a pedigree with six affected individuals and an association of nasal dermoid sinus cyst and third ventricle colloid cyst. Whether patients or pedigrees with nasal dermoid sinus cyst (NDSC) and third ventricle colloid cysts represent a previously unrecognized syndrome or belong to the normal phenotypic spectrum of NDSC remains unclear. Our patient material suggests that only minority of NDSCs seem to be familial.

Unusual variants of midline nasal dermoid cysts: a series of three cases

OBJECTIVE

Dermoids presenting in early life with a sinus tract along the midline of the nasal dorsum are well described. We present three very unusual variants of this condition.

METHODS

Case one was a two-year-old child with a pit in the philtrum of the lip. The tract pierced the nasal spine and extended towards the crista galli. Case two was a 15-month-old child with two separate sinus openings on the dorsum, one below and one above a dermoid cyst. Case three was a 17-year-old adolescent with neurological disability. Scanning showed a dermoid cyst deep in the anterior skull base, but the sinus tract had been obliterated by bony overgrowth due to long term use of antiepileptic medication.

RESULTS

Cases one and two were successfully managed by complete excision via an external rhinoplasty approach. Case three, in contrast, was not operated upon due to bony obliteration of the sinus tract.

CONCLUSION

Surgeons dealing with nasal dermoids must be able to adapt to the variable anatomical and clinical features of these lesions.

A case of a nasal dermoid presenting as a median upper lip sinus

Nasal dermoids are uncommon developmental abnormalities. Median upper lip fistulas are even rarer and recognized as a separate pathology. The authors present the unusual case of a child with a sinus on the philtrum of the upper lip and a sinus tract passing all the way to the anterior skull base through the nasal septum. The authors propose that nasal dermoids and medial upper lip fistulas have a common aetiology, and may be the same entity. The authors suggest they should all be managed like nasal dermoids and have MRI scanning prior to theatre. If the lesion extends into the nose, excision by external rhinoplasty is the preferred option.

Nasomaxillary dermoid

Facial dermoids are uncommon. We present the first case of a nasomaxillary dermoid since Bramann's original 1890 description. A dermoid sinus in this location further supports Bland-Sutton's hypothesis of ectodermal sequestration between embryologic facial prominences. Contralateral cleft lip and palate in our patient suggest a common pathogenesis involving abnormal formation of the maxillary prominences and failure of fusion and merging.

[Congenital cysts, sinuses and fistula of head and neck]

Congenital cervical cysts, sinuses and fistulae are uncommon malformations. Diagnosis and management of congenital cervical cysts, sinuses and fistulae requires a good understanding of their embryological development and topography. Thyroglossal duct cysts are most common, followed by branchial cleft anomalies and dermoid cysts. In this review, we discuss both the classical and current aspects of these malformations.

[Nasal dermoid and sinus cysts in patients with cleft malformations]

BACKGROUND

Nasal dermoid sinus cysts are uncommon congenital lesions. They are usually isolated occurrences and are not associated with syndromes or additional malformations. The coincidence of both, cleft malformations and nasal dermoid sinus cysts, has seldom been reported.

CASE REPORTS

Within the last 2 years two patients with reconstructed cleft lip and palate and additional nasal dermoid sinus cysts underwent surgical removal. One patient with bilateral complete cleft lip exhibited a fistula from the medial third of the nasal dorsum up to the glabella. Another patient with unilateral cleft lip and Peters' plus syndrome had undergone removal of a nasal dermoid sinus cyst 12 years ago and was referred for management of recurrent disease.

DISCUSSION

Concerning the common cleft-dependent nose malformations with no midline nasal masses, there are reasons for the assumption that a coincidence of both anomalies might be accidental. Especially in Peters' plus syndrome no frequent occurrence of nasal dermoids has thus far been documented. However, the proximity and temporal closeness of an embryological pathway of the frontonasal region and lip development could also argue for a unique formation of both lesions. Complete surgical removal and plastic reconstruction simultaneously or in a second step are recommended.

Nasal Dermoid Sinus Cysts

Nasal dermoid sinus cysts are uncommon congenital anomalies presenting either as cysts or sinuses. They are frequently associated with extension into the intracranial space, requiring craniotomy for adequate resection. At the Royal Children's Hospital in Melbourne, Australia, we have managed 25 patients with nasal dermoid sinus cysts over 8 years and present details of clinical features, preoperative assessment, and surgical management. Six patients presented with infection, including 1 with osteomyelitis. Four of our patients had intracranial extension of their lesions, and all were treated successfully with tailored investigation and appropriate surgical procedures. Insights into diagnosis, investigation, and surgery are offered to facilitate the management of these challenging lesions.

Congenital isolated midline sinus of the upper lip: clinical and embryological approaches

OBJECTIVES

Congenital sinuses or fistulas of the lip are uncommon malformations, yet true medial upper-lip fistulas (MULFs) are extremely rare. We present a new case of congenital upper-lip fistula located in the midline of the philtrum of an 8-month-old girl.

INTERVENTION

Complete surgical removal was performed with a combined extra- and intraoral approach. Histological examination revealed that the fistula was lined by squamous epithelium with sebaceous and mucous glands and hair follicles.

RESULTS

Several embryological hypotheses have been proposed concerning these anomalies. This article reexamines and discusses major embryological theories on pathogenesis of sinuses or fistulas of the upper lip. We propose that early ectodermal inclusion events may occur in the medial fusion area during formation of the intermaxillary process. This embryological approach is highly concordant with our recent hypothesis on nasal dermoid sinus cysts (NDSCs) pathogenesis, in which we proposed an embryological hypothesis with early ectodermal inclusion phenomenon in the midline suture area to explain NDSCs pathogenesis.

CONCLUSIONS

Common early ectodermal inclusion phenomena could be involved in both NDSCs and MULFs pathogenesis.

Bibliography. Current world literature. Nose and paranasal sinuses

PURPOSE OF REVIEW

Patients with advanced head and neck cancer are being treated with chemo-radiotherapy, and life is being prolonged, with or without persistent disease, for longer than was previously. Hypercalcaemia may present in patients with advanced or disseminated head and neck cancer, and, as such, these patients may present to a larger variety of clinicians for advice concerning their symptoms and illness. Modes of presentation of hypercalcaemia and treatment strategies are reviewed.

RECENT FINDINGS

There were previously few large series of head and neck cancer patients diagnosed with hypercalcaemia, which may or may not have been related to their cancer being treated. Investigations, by way of blood/serum calcium level, may identify such patients. Patients with cancer-related hypercalcaemia have a poor prognosis, but many may respond temporarily to treatment when offered, with an improvement of their quality of life and death.

SUMMARY

Hypercalcaemia should and must be considered in all patients who have or possibly have a diagnosis of a head and neck cancer and who present unwell with symptoms of fatigue, lethargy and somnolence. Investigation must include serum calcium (corrected for serum albumin binding) and parathyroid hormone level. Patients may be treated by a combination of rehydration and bisulphonate therapy until the serum calcium is reduced to a level below 3 mmol/l. The majority of patients diagnosed with hypercalcaemia due to head and neck malignancy die of their diseases in the short term, but some may enjoy a prolongation of life with reasonable quality if diagnosed and treated aggressively.

[Nasal glial heterotopia: embryological and clinical approaches]

INTRODUCTION

Nasal gliomas or heterotopia are nonhereditary congenital malformations composed of heterotopic neuroglial tissue. They usually present in infancy. Evaluation should include preoperative imaging with CT scan and/or MRI to rule out intracranial extension. There have been several cases reported in which nasal gliomas were misdiagnosed as capillary hemangiomas. The differential diagnosis includes prenasal space developmental impairment, which are nasoethmoidal meningoencephaloceles, nasal dermoid and epidermoid cysts.

CASE REPORT

We describe the case of a newborn male infant presenting at birth with a paramedial nasal glioma. An embryological and clinical analysis of nasal gliomas is proposed.

DISCUSSION

Nasal glioma is an uncommon congenital lesion presenting as a large panel of midline craniofacial anomalies. The embryological and anatomical origins of nasal gliomas are reviewed. The most known embryological theory was described by Grünwald in 1910 and is called the "prenasal space" theory. This theory is very attractive because of the embryopathogenic continuum proposed among dermoids, gliomas, and encephaloceles. In this article, we discuss major embryological theories on nasal gliomas pathogenesis and propose that while the prenasal space theory can explain the occurrence and the continuum between basal anterior or prenasal encephaloceles and gliomas, it cannot explain the occurrence of craniofacial demoids of the same topography. Better knowledge of embryological mechanisms implicated in the pathogenesis of nasal gliomas can help clinical management of this kind of malformations.