What Is a Nasal Dermoid Cyst?
An unusual kind of cyst known as a nasal dermoid cyst forms when skin and other tissues get stuck along the nose's midline during fetal development. Usually, it appears as a painless lump between the eyebrows or close to the nose bridge. Because of their location and barbell-shaped morphology, nasal dermoid cysts differ greatly from other dermoid cysts. A pediatric neurosurgeon is required to treat these uncommon cysts.
A nasal dermoid cyst forms at the base of the skull during fetal development. The circular lump does not move as the nose shapes. As it grows, a tube emerges from the spherical mass in the direction of the nose tip. Another spherical lump eventually appears at the tube's end. As a result, a cyst with a barbell structure develops along the nasal cartilage and bone.
A nasal dermoid cyst requires surgical excision of the entire structure to be properly treated. If the dermoid cells stay in place, the cyst can regrow.
How Common Is Nasal Dermoid Cyst?
Nasal dermoids are far less prevalent than angular dermoids, making up just 4-12 percent of all head and neck dermoid cysts. However, they cause 61 percent of all cases of congenital midline nasal lesions, making them the most common type. There is a minor preference for men. An additional 40 percent of congenital anomalies are frequently observed, with many being facial.
Among them are:
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Hearing loss.
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Abnormalities of branchial clefts.
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Hypertelorism (increased distance between two body parts, generally eyes), hemifacial microsomia (a condition in which half of the face does not grow normally), and cleft lip and palate.
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There are several cardiac, central nervous system, gastrointestinal, and urogenital disorders among the other non-facial defects that are observed.
How Does Nasal Dermoid Cyst Occur?
A diverticulum of dura extends from the foramen cecum, before the crista galli (wedge shaped bone seen in the ethmoid bone of the skull), all the way to the nose's skin as the midface develops. This happens in weeks eight and nine of gestation. Usually, this diverticulum is temporary and fully involuted; nevertheless, on rare occasions, skin cells are drawn back along its path during this process. These cells cause cysts to form that are packed with hair, desquamated skin cells, and sebaceous material if the tract is obliterated in any other way. Alternatively, a sinus might continue to exist, allowing this substance to escape.
How Does Nasal Dermoid Cyst Appear?
Most nasal dermoids appear within the first three years of life and can often remain unnoticed until maturity. This is especially true in the absence of a surface component.
Although nasal dermoids can occur anywhere from the nasal subcutaneous tissues to the anterior cranial fossa, most are limited to the nasal bones' superficial region. They manifest as a midline lump from the superior glabella to the base of the columella. When intracranial pressure increases, these lesions do not expand (Furstenberg sign is negative). There may occasionally be a sinus-like opening through which sebaceous fluids may leak or, less frequently, hair may protrude.
Up to 45 percent of cases involve lesions with tracts extending to the anterior cranial fossa's foramen cecum. Even in cases with a deep component, it is rare for an illness to spread from its common local site to the cerebral compartment.
What Are the Symptoms of Nasal Dermoid Cyst?
Sometimes, nasal dermoid cysts go unnoticed or are misdiagnosed.
On the tip of the nose, warning indicators include:
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Rust-colored area.
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Little pimple or lump that is growing or persisting.
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Tiny black patch.
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Little skin hole that could let milky fluid out.
A hole at the tip of the nose could result from an untreated nasal dermoid cyst. The child could get meningitis or an infection in the nose. A further danger is that the cyst may push into the base of the skull and the brain.
How to Diagnose Nasal Dermoid Cyst?
Most juvenile cases of nasal dermoid cysts are discovered before the age of five. If the pediatrician thinks the child might have a nasal dermoid cyst, the next course of action is to see a pediatric plastic surgeon, neurosurgeon, or ear, nose, and throat (ENT) surgeon. The doctor will assess the child and request imaging studies to find out more. Magnetic resonance imaging (MRI), computed tomography (CT) scans, or both are examples of imaging.
What Is the Treatment of Nasal Dermoid Cyst?
The following are the treatment procedures employed for
Surgical Procedure:
A nasal dermoid cyst may require extensive surgery to be removed. Although quite intrusive, this kind of surgery is very effective. To access a portion of the dermoid cyst, the surgeon must remove a portion of the nasal bone. To reach the remaining cyst, parts of the skull must be removed. Patients must stay in the hospital for several days because of the significant edema around their eyes and a noticeable scar on their scalp.
Minimally Invasive Procedures:
At certain pediatric institutions, pediatric neurosurgeons utilize endoscopic procedures to provide a minimally invasive alternative. During this procedure, a plastic surgeon creates an incision (cut) near the tip of the nose, removing a portion of the cyst. An endoscope, a tiny, tube-shaped camera, is inserted along the nasal bone and moved toward the base of the skull.
An ENT surgeon and a neurosurgeon insert tiny surgical instruments through the nose. The tube and the spherical mass around the base of the skull are used to remove the remaining portion of the cyst. Thanks to advanced imaging, the neurosurgeon can observe the cyst and nasal tissues throughout the procedure. With this method, there is very little swelling or scarring, an overnight hospital stay, and a short recuperation time spent at home.
What Are Differential Diagnosis of Nasal Dermoid Cyst?
The primary differential is with various lesions of the midline nasal region, such as:
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Nasal glioma (uncommon congenital tumors of the midline made of heterotopic neuroglial tissue).
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Nasal epidermoid cyst (a cyst that develops from the outermost layer of skin).
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Nasal encephalocele (happens when the skull of a developing infant fails to shut entirely).
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Lipoma (fatty lump seen between the skin and underlying muscle layer).
Conclusion
In conclusion, a nasal dermoid cyst is a rare developmental aberration that needs to be treated because it might lead to difficulties and cosmetic problems. Early detection and surgical intervention are usually advised to stop the growth and treat any related symptoms. People with nasal dermoid cysts can effectively control their disease and reduce the risk of complications by obtaining quick medical examination and treatment.
