Aim: To present a rare case of nasal dermoid cyst and its management in a 14-year-old boy. Background: Congenital midline nasal masses are rare, with an incidence estimated to be 1 in 20,000 to 1 in 40,000. Among these, nasal dermoid cyst is commonest. They arise from the lines of embryonic fusion. Various theories have been postulated in the development of nasal dermoid cyst, and prenasal theory by Pratt is the most accepted one. Case report: A 14-year-old boy presented with a gradually progressive midline swelling since birth, which was solitary, soft, nontransilluminant, present over the lower dorsum and tip region. Based on the history, clinical examination, and serial relevant investigations, diagnosis of a nasal dermoid cyst was made. Surgical strategy planned was dermoid cyst extirpation via an open rhinoplasty approach and augmentation of the defect with an autologous conchal cartilage graft. Conclusion: Nasal dermoid cyst is a rare congenital anomaly. Presence of intracranial extensions, sinus formation, and other differential diagnosis should be ruled out preoperatively. It demands early surgical intervention in order to avoid further distortion of the nose or atrophy of the bony or cartilaginous component as a result of pressure secondary to the growth of cyst and infection. Clinical significance: • This midline congenital cyst is cosmetically unacceptable. Hence, early surgical removal is mandatory. • Open rhinoplasty is the preferred surgery as it gives good esthetic results. It gives a scope for augmentation of the defect following the extirpation of the cyst. • Autologous conchal cartilage is the preferred graft as it provides sufficient quantity and esthetically pleasing contour.
Tatar EC, Selcuk ÖT, Saylam G, Özdek A, Korkmaz H. The management of rare nasal mass-nasal dermoid sinus cysts: open rhinoplasty. Rare Tumors 2009 Dec;1(2):e40.
Rahbar R, Shah P, Mulliken JB, Robson CD, Perez-Atyade AR, Proctor MR, Kenna MA, Scott MR, McGill TJ, Healy GB. The presentation and management of nasal dermoid. Arch Otolaryngol Head Neck Surg 2003 Apr;129(4):464-471.
Al-Reefy H, Hopkins C, Jonas N. The open access atlas of otolaryngology, head and neck operative surgery. Surgery for Nasal Dermoids. www.entdev.uct.ac.za
Guruprasad Y, Chauhan DS. Midline nasal dermoid cyst with Tessiers 0 cleft. J Nat Sci Biol Med 2014 Jul;5(2):479-482.
Kim JH, Wang JH, Jang YJ. Excision of a nasal dermoid sinus cyst via open rhinoplasty approach and primary reconstruction using tutoplast-processed fascia lata. Clin Exp Otorhinolaryngol 2010 Mar;3(1): 48-51.
Wang IJ, Lin SL, Tsou KI, Hsu MC, Chiu WT, Tsai ST, Lee LM, Lin TJ. Congenital nasal midline mass: case series and review of literature. Turk J Paediatr 2010 Sep-Oct;52(5):520-524.
Yildiz H, Cil Y, Simsek HA, Erginay T. Recurrent adult nasal dermoid cyst. J Cutan Aesthet Surg 2011 May-Aug;4(2): 151-152.
Sessions RB. Nasal dermal sinuses: new concepts and explanations. Laryngoscope 1982 Aug;92(8 Pt 2 Suppl 29):1-28.
Bland SJ. A note on dermoid cysts of the scalp and mid-line of the back. Ann Surg 1889 Jul-Dec;10:81-86.
Pratt LW. Midline cysts of nasal dorsum: embryologic origin and treatment. Laryngoscope 1965 Jun;75:968-980.
Gupta M, Chaudhary N. External rhinoplasty for dorsum swellings. Indian J Otolaryngol Head Neck Surg 2007 Jan- Mar;59(1):60-62.
Sood, VP. Corrective rhinoplasty. 3rd ed. New Delhi: CBS Publishers & Distributors Pvt. Ltd.; 2013. pp. 134-139.
Choe KS, Sclafani AP, Litner JA, Yu GP, Romo T 3rd. The Korean American woman's face: anthropometric measurements and quantitative analysis of facial aesthetics. Arch Facial Plast Surg 2004 Jul-Aug;6(4):244-252.
Perkins S, Patel A. Endonasal suture techniques in tip rhinoplasty. Facial Plast Surg Clin North Am 2009 Feb;17(1):41-54.
Toriumi DM. Structure approach in rhinoplasty. Facial Plast Surg Clin North Am 2002 Feb;10(1):1-22.
Dobratz EJ, Tran V, Hilger PA. Comparison of techniques used to support the nasal tip and their long-term effects on tip position. Arch Facial Plast Surg 2010 May-Jun;12(3):172-179.
Friedman O, Koch CA, Smith WR. Functional support of the nasal tip. Facial Plast Surg 2012 Apr;28(2):225-230.
Mohebbi A, Jahandideh H, Faham Z, Jafari M. Defining the best nasal tip projection among Iranian women. Plast Surg Int 2016;2016:8549276.
Bhattacharyya N. Bacterial infection in chronic rhinosinusitis: a controlled paired analysis. Am J Rhinol 2005 Nov- Dec;19(6):544-548.
Boase S, Foreman A, Cleland E, Tan L, Melton-Kroft R, Pant H, Hu FZ, Ehrlich GD, Wormald PJ. The microbiome of chronic rhinosinusitis: culture, molecular diagnostics and biofilm detection. BMC Infect Dis 2013 May;13:210.
Mantovani K, Bisanha AA, Demarco RC, Tamashiro E, Martinez R, Anselmo-Lima WT. Maxillary sinuses microbiology from patients with chronic rhinosinusitis. Braz J Otorhinolaryngol 2010 Sep-Oct;76(5):548-551.
Brook I, Gober AE. Recovery of potential pathogens in the nasopharynx of healthy and otitis media-prone children and their smoking and nonsmoking parents. Ann Otol Rhinol Laryngol 2008 Oct;117(10):727-730.
Wu J, Peters BA, Dominianni C, Zhang Y, Pei Z, Yang L, Ma Y, Purdue MP, Jacobs EJ, Gapstur SM, et al. Cigarette smoking and the oral microbiome in a large study of American adults. ISME J 2016 Mar;10(10):2435-2446.
Ertel A, Eng R, Smith SM. The differential effect of cigarette smoke on the growth of bacteria found in humans. Chest 1991 Sep;100(3):628-630.
Reh DD, Higgins TS, Smith TL. Impact of tobacco smoke on chronic rhinosinusitis: a review of the literature. Int Forum Allergy Rhinol 2012 Sep-Oct;2(5):362-369.
Lee KI, Kim DW, Kim EH, Kim JH, Samivel R, Kwon JE, Ahn JC, Chung YJ, Mo JH. Cigarette smoke promotes eosinophilic inflammation, airway remodeling, and nasal polyps in a murine polyp model. Am J Rhinol Allergy 2014 May-Jun;28(3):208-214.
Kumar PS, Matthews CR, Joshi V, de Jager M, Aspiras M. Tobacco smoking affects bacterial acquisition and colonization in oral biofilms. Infect Immun 2011 Nov;79(11): 4730-4738.
Namiot Z, Namiot DB, Kemona A, Gołebiewska M, Bucki R. The effect of cigarette smoking and alcohol consumption on efficacy of Helicobacter pylori eradication. Pol Arch Med Wewn 2000 Sep;104(3):569-574.
Linder JA, Sim I. Antibiotic treatment of acute bronchitis in smokers: a systematic review. J Gen Intern Med 2002 Mar;17(3):230-234.
Lee WK, Ramanathan M Jr, Spannhake EW, Lane AP. The cigarette smoke component acrolein inhibits expression of the innate immune components IL-8 and human betadefensin 2 by sinonasal epithelial cells. Am J Rhinol 2007 Nov-Dec;21(6):658-663.
Kamath PM, Shenoy VS, Mittal N, Sharma NK. Microbiological analysis of paranasal sinuses in chronic sinusitis—a south Indian coastal study. Egypt J Ear Nose Throat All Sci 2013 Nov;14(3):185-189.
Bezerra TF, Pádna FG, Ogawa AI, Gebrim EM, Saldiva PH, Voegels RL. Biofilms in chronic rhinosinusitis with nasal polyps: pilot study. Braz J Otorhinolaryngol 2009 Nov- Dec;75(6):788-793.
Hashemi M, Sadeghi MMM, Omrani MR, Torabi MA. Microbiology and antimicrobial resistance in chronic resistant rhino sinusitis with or without polyp after functional endoscopic sinus surgery. J Res Med Sci 2005;10(3):167-171.
Farahani F, Youse Mashouf R, Hashemian F, Esmaeili R. Antimicrobial resistance patterns of aerobic organisms in patients with chronic rhinosinusitis in Hamadan, Iran. Avicenna J Clin Microb Infec 2014 Aug;1(2):e18961..