Nasal Dermoid: A Segmental Approach

Background/ Purpose: Nasal Dermoid is a rare congenital anomaly. It represents persistent contact between the ectoderm and neuro-ectoderm at the prenasal space. The purpose of this study is to present the behavior of nasal dermoids, details of operative findings and results of management. An approach to the problem based on segmental divisions of the lesion has been also proposed. Patients& Methods: Six cases of nasal dermoids were diagnosed and successfully treated at the Children’s Hospital, Cairo University during the period from June 2004 to October 2008. Results: The average age at presentation was 2.4 years. The clinical presentations were diverse. The most common was illdefined facial midline swelling (n=3). Others included paramedian swelling, midline and paramedian sinuses. Operative findings revealed almost identical behavior of the lesion in every case. Based on these operative findings, the lesion can be divided into four distinct segments: the proximal nasal dimple, the main tract, the central attachment and the accessory tract. Complete removal implies resection of all segments. Open facial approach was used in all cases in the form of either midline or modified lateral rhinotomy incision. One case showed minimal cerebrospinal fluid (CSF) leak that spontaneously stopped. There were no other medical or surgical complications. The mean follow up period was 15 months. No evidence of recurrence was noted in any patient. The final aesthetic outcome was satisfactory. Conclusion: Nasal dermoid is a rare and often clinically underestimated congenital anomaly. Applying the concept of “track segments” is helpful in surgical planning and complete excision. The open facial approach provides generous exposure and allows complete resection with satisfactory esthetic outcome.