Midline Approach to Pediatric Nasofrontal Dermoid Cysts

Ortlip, Timothy; Ambro, Bryan T.; Pereira, Kevin D.

doi:10.1001/jamaoto.2014.3185

Cited by 23 publications

(32 citation statements)

References 10 publications

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“…This type of incision [14,15], as well as the use of resorbable sutures [16], is recommended for a more pleasing scar in transcollumellar incisions and dacryocystorhinostomy. Although many advocate a limited local incision in children [6,17], the approach to a glabellar cyst can be achieved through an anterior hairline incision at the superior forehead [2]. A hairline incision provides a good cosmetic result and avoids surgical manipulation of the nasal cartilages or septum minimizing the potential for growth disturbances.…”

Section: Discussionmentioning

confidence: 99%

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

Wales

Alinasab

Fridman-Bengtsson

2020

Acta Oto-Laryngologica Case Reports

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A dermoid cyst of the nose is a relatively rare anomaly seen normally in the first few years of life. They are distinct to dermoid cysts located elsewhere in the body as there is a potential for extension to intracranial structures. Presentation in adulthood is rare and often because of a missed diagnosis in childhood. We present the case of an adult man with a superficial nasal dermoid cyst presenting over the nasion. The operation was performed by direct excision at the nasion with a novel modified horizontal zigzag skin incision, instead of the traditional vertical excision, with a good cosmetic result. The cyst was radically excised and there was no evidence of extension intracranially. The case is discussed in relation to the current surgical literature in both children and adults.

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Section: Discussionmentioning

confidence: 99%

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

Wales

Alinasab

Fridman-Bengtsson

2020

Acta Oto-Laryngologica Case Reports

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“…The most common external incisions include the following: vertical midline, transverse linear or curvilinear, lateral rhinotomy, open rhinoplasty, and glabellar. 5,11 Techniques for intracranial excision have focused on a frontal craniotomy with or without a keystone osteotomy, smaller keystone osteotomies, and endoscopic treatment.…”

Section: Discussionmentioning

confidence: 99%

“…15 A vertical midline incision is required for excision of the cutaneous extension of the dermoid sinuses and can easily be extended incrementally for further access. 11 Nasal bone removal allows clear visualization of the entire sinus tract, from the subcutaneous nasal surface to its communication with the anterior cranial fossa. Because we do not have to fragment the dermoid, the chance of leaving any dermoid tissue behind is very low.…”

Section: Discussionmentioning

confidence: 99%

Nasal dermoid cysts with intracranial extension: avoiding coronal incision through midline exposure and nasal bone osteotomy

Purnell

Skladman

Alden³

et al. 2020

Journal of Neurosurgery: Pediatrics

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OBJECTIVEUp to 10% of midline nasal dermoid cysts have intracranial extension. Previous techniques of excision include frontal and frontonasal craniotomies via a coronal approach, combined with a direct cutaneous excision of the dermoid cyst. While the coronal incision allows for wide visualization, it carries significant risks of transfusion, blood loss, and scarring. The authors present an alternative technique in which access is gained through a midline extension of the dermoid cyst excision that provides direct access for a keyhole frontal craniotomy.METHODSThe authors utilize a nasal bone osteotomy, pericranial flap, and keyhole-type craniotomy performed through a nasal midline incision for the treatment of nasal dermoid cysts with intracranial extension. They performed a retrospective chart review of all patients with nasal dermoid cysts treated at the Ann & Robert H. Lurie Children’s Hospital of Chicago from 2009 to 2017. Patient demographic data, operative data, and in- and outpatient complication data were collected.RESULTSIn 10 patients with cyst extension near or into the intracranial cavity (7 with true intracranial extension), the nasal osteotomy technique was performed. The mean blood loss was 13 ml, with a 0% transfusion rate. The mean length of inpatient stay was 1 day. A durotomy was made and repaired as part of the dermoid cyst dissection in 3 patients. One patient underwent intraoperative placement of a lumbar drain. The mean operative time was 228 minutes. There were no intraoperative or postoperative complications, including the need for a reoperation. No patients had any long-term complications, and no patients have had dermoid cyst recurrence. The appearance of the scar was acceptable in all cases.CONCLUSIONSThe midline approach to nasal dermoid cysts with intracranial extension is safe and results in limited blood loss, short operative times, and short lengths of inpatient hospital stay. This is a viable technique for the treatment of this challenging pathology.

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“…Nasal dermal cysts usually present at a young age as a mass from the glabella to the columella. [ 1 – 5 ] Nasal dermal cysts can open onto the dorsal nasal skin as an external dimple or a small pit containing a tuft of hair. [ 3 , 4 ] They are confined to the superficial nasal region in up to 50% of cases, but intracranial extension occurs in approximately 10% to 45% of these lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Nasal dermoid cysts are rare congenital lesions and may present as a midline nasal swelling. [ 1 – 5 ] Nasal dermoid cysts usually present at birth and are commonly diagnosed by 3 years of age. [ 2 – 4 ] Therefore, they are rarely found in adults, as in our patient.…”

Section: Introductionmentioning

confidence: 99%

Dermoid cyst of nasal septum in an adult patient

et al. 2018

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Rationale:Nasal dermoid cysts are rare congenital lesions and may present as a midline nasal swelling. Nasal dermoid cysts usually present at birth and are commonly diagnosed by 3 years of age. An incidentally detected nasal dermoid cyst in an adult patient is extremely rare.Patient concern:We report an unusual case of an adult patient with an incidentally diagnosed dermoid cyst of the nasal septum, which presented as a longstanding discharging pit in the nasal columella since childhood.Diagnosis:A preoperative diagnosis of dermoid cyst of the nasal septum was made.Intervention:We performed the external rhinoplasty incision, including a small elliptical incision for removal of the columella pit.Outcome:There has been no evidence of recurrence during the 2-year follow-up.Lessons:An incidentally detected nasal dermoid cyst in an adult patient is extremely rare. The most important point for the preoperative diagnosis of nasal dermoid cysts is to identify the presence or absence of intracranial extension. The treatment of choice for nasal dermoid cysts is complete surgical excision with clear margins.

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Midline Approach to Pediatric Nasofrontal Dermoid Cysts

Cited by 23 publications

References 10 publications

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

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

Nasal dermoid cysts with intracranial extension: avoiding coronal incision through midline exposure and nasal bone osteotomy

Dermoid cyst of nasal septum in an adult patient

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