Nasal Dermoid Sinus Cyst expanding into Frontal Sinus: A Rare Presentation

Abstract

Nasal dermoid sinus cysts are uncommon congenital anomalies that require interventions only when they present as complications. They frequently present in childhood as midline nasal masses requiring excision. They may present with intracranial as well as intraorbital extensions, making it necessary to subject the patient for proper radiological diagnosis preoperatively. Here, we present a rare case report of 28-yearold male patient who presented at our tertiary health care center with nasal dermoid cyst expanding into the frontal sinus causing proptosis and blurring of vision. The cyst was excised by combined approach, i.e. external nasal dermoid sinus tract excision and endoscopic nasofrontal sinusotomy for complete removal. The embryology, clinical history, diagnosis and surgical management are discussed.

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

“…Minimally invasive technique such as open rhinoplasty alone or combined with additional local skin excision of the cyst is an optimal approach for removing NDSC used by many authors with achievement of favourable results, both aesthetically and functionally [ 10 – 12 , 22 , 35 ]. According to the information presented in Table II , this technique has been widely used for removing NDSCs with both an extracranial [ 2 ] and intracranial extradural extension [ 36 , 37 ].…”

“…This is primarily due to the presence of characteristic signs and symptoms (e.g., external nose deformation or pathognomonic hair concentration protruding from the sinus canal on the skin above the lesion, often accompanied by periodic ‘cheesy’-like sebaceous and keratin discharge) [ 10 , 11 , 13 , 18 ]. NDSCs diagnosed in adulthood are rare, with only two published cases involving the frontal sinus [ 4 , 19 – 22 ].…”

“…Approximately 39% to 84% of head and neck dermoid cysts are located in the periorbital region [ 5 , 6 , 22 , 23 ], most of which are localized in the superior temporal zygomatico-frontal suture, and about 10% are localized in the superior nasal frontal suture [ 24 ]. NDSCs with an orbital extension are also described in the literature [ 22 , 25 ] and their symptoms include swelling in the periorbital region with deteriorating vision and eye displacement (i.e., proptosis, ptosis or diplopia) [ 19 , 20 , 22 ]. Additionally, since limited forehead or upper eyelid swelling may occur, complications of frontal sinusitis should be taken into consideration during the differential diagnosis, especially when patients do not respond to standard treatment [ 4 , 19 – 22 , 26 ].…”

“…Treatment of NDSCs is based on the possibility of surgical excision, which depends on the location, size, and intracranial extension of the lesion [ 2 , 16 ]. Complications of untreated NDSCs include spontaneous local infection with frontal bone osteomyelitis, and abscess formation, which can be incorrectly interpreted as a lacrimal sac abscess when medial canthus swelling is present [ 10 , 18 , 22 , 29 ]. Moreover, long-lasting inflammation can lead to deformations of the nasal bones and cartilage, or even atrophy [ 8 , 13 ].…”

“…Approximately 39% to 84% of head and neck dermoid cysts are located in the periorbital region [5,6,22,23], most of which are localized in the superior temporal zygomatico-frontal suture, and about 10% are localized in the superior nasal frontal suture [24]. NDSCs with an orbital extension are also described in the literature [22,25] and their symptoms include swelling in the periorbital region with deteriorating vision and eye displacement (i.e., proptosis, ptosis or diplopia) [19,20,22].…”