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

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.

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

“…This explains the reported case of a bilateral NDSC causing erosion of the frontal bones imitating a Pott's puffy tumour in a 7-monthold male patient [32]. Since the frontal sinuses had not yet been pneumatized at the time of the diagnosis, frontal sinus involvement may be not possible until adolescence in cases of slower NDSC development [32]. Our presented case affirms this assumption.…”

“…The appearance of the frontal sinus begins during the second year of life, although the sinus may not be radiologically observed until the sixth year, and growth continues until the second decade of life [31]. This explains the reported case of a bilateral NDSC causing erosion of the frontal bones imitating a Pott's puffy tumour in a 7-monthold male patient [32]. Since the frontal sinuses had not yet been pneumatized at the time of the diagnosis, frontal sinus involvement may be not possible until adolescence in cases of slower NDSC development [32].…”

“…An additional elliptical skin incision is necessary for complete NDSC removal in cases involving opening of the skin of the NDSC sinus tract, which is in accordance with the method used to treat our patient [2,16,17,27,29]. For smaller lesions, resection using only this method is possible [11,32]. Moreover, transnasal endoscopic approaches without any skin interference are reserved only for select cases of NDSC without skin involvement, limited to the intranasal space, with or without intracranial involvement [13].…”

A superficial nasal dermoid cyst excised through a novel horizontal zig-zag incision in a 49-year-old man

“…NDCs are unique in comparison to other dermoid cysts in the body as there is a potential for the involvement of deeper structures or to extend intracranially. This extension can put the patient at risk of meningitis, intracranial or orbital abscess, convulsions or cavernous sinus thrombosis with infection [4,5]. As this is a congenital lesion, the usual age of presentation is during childhood (mean age 14-34 months [2]).…”

Paediatric nasal dermoid: evaluation and management

“…In addition, a midline nasal hair or tuft of hair may be the only clinical examination finding in some children and should prompt suspicion for an underlying nasal dermoid lesion. A recent case report described an infant who presented with bilateral subperiosteal supraorbital abscesses secondary to an infected nasal dermoid in which a nasal tuft was initially missed [9].…”