Paediatric nasal dermoid: evaluation and management

Abstract

Purpose of review The aim of this study was to present the evaluation and current management of congenital paediatric nasal dermoid. Recent findings There has been a trend towards less invasive surgical excision techniques, including purely endoscopic excision, endoscopic-assisted approaches and midline excision with nasal bone osteotomies and bone flap. These approaches allow adequate access for both total resection and nasal contour and skull base reconstruction. Following resection, if nasal bone osteotomies are insufficient for restoring nasal appearance, free temporoparietal fascial graft and/or conchal cartilage can be considered. For nasal tip deformities, interdomal sutures and free fat grafting are a suitable option. Summary Complete surgical excision remains the treatment of choice for nasal dermoid lesions. The surgical approach taken and reconstruction depends on the type of lesion (cyst versus sinus or fistula), location (intranasal versus extranasal), whether or not there is intracranial extension, and experience of the surgical team.

Extended External Rhinoplasty Approach For Nasal Dermoids With Intracranial Extension

“…Frontal or frontonasal craniotomy following bicoronal incision, which is the traditional approach for excision of nasal dermoids with intracranial extension, has fallen out of favor due to relatively high morbidity. 1,4 In evaluating alternative approaches to resecting nasal VIDEO 1. Narrated presentation of the extended external rhinoplasty approach for resection of nasal dermoid with intracranial extension.…”

“…1 They can be intranasal or extranasal with or without intracranial extension and are most commonly located on the nasal dorsum. 1 The reported incidence of intracranial extension is highly variable ranging from 4% to 45%. 2 Apart from cosmetic issues and recurrent drainage, nasal dermoids are associated with complications including recurrent infection that may lead to meningitis or brain abscess.…”

“…3 Complete surgical resection is recommended for management as recurrence is high in incomplete resections with reported rates as high as 100%. 1,4 The most appropriate approach for surgical management of nasal dermoids with intracranial extension depends on the extent of the intracranial extension, the experience of the surgeon and the presence of an expert endoscopic skull base surgeon and instrumentation. Traditionally, nasal dermoids with intracranial extension are removed following bicoronal incision and frontal or frontonasal craniotomy.…”

“…4 This provides great exposure of the dermoid tract; however, it increases the risk of alopecia, unfavorable scarring, meningitis, hyposmia, CSF leakage, damage to frontal and sagittal sinuses, and other complications related to brain retraction. 1,4 Other approaches have been developed to strike a balance between intraoperative exposure and minimizing scar. One such approach more recently described involved a midline incision with nasal bone osteotomy and keyhole craniotomy.…”

“…Nasal dermoids are uncommon lesions with an incidence of approximately 1:20,000–1:40,000 1 . They can be intranasal or extranasal with or without intracranial extension and are most commonly located on the nasal dorsum 1 . The reported incidence of intracranial extension is highly variable ranging from 4% to 45% 2 .…”