Nasal dermoid cyst

Nasal dermoid cyst (also known as nasal dermoid sinus cyst or nasal dermal sinus cyst) is a rare congenital developmental anomaly that presents as a cystic or sinus-like lesion along the nasal dorsum, from the glabella (area between the eyebrows) to the nasal tip. It is the most common congenital midline nasal mass, accounting for approximately 61% of such lesions in children. Nasal dermoid cysts arise from abnormal embryological development, likely due to incomplete regression of the dural diverticulum that normally projects through the fonticulus frontalis (prenasal space) during fetal development. This results in trapped ectodermal elements (skin, hair follicles, and sebaceous glands) within the nasal tissues. Clinically, nasal dermoid cysts typically present at birth or in early childhood as a firm, non-compressible midline nasal mass, often with a visible pit or sinus opening on the nasal dorsum from which hair may protrude. The lesion does not transilluminate and does not change in size with crying or straining (which helps distinguish it from encephaloceles or gliomas). Patients may experience recurrent local infections, nasal obstruction, or cosmetic concerns related to nasal broadening. An important clinical consideration is that approximately 4–45% of nasal dermoid cysts may have an intracranial extension through the cribriform plate or foramen cecum, which can lead to serious complications including meningitis or intracranial abscess if not properly identified. Diagnosis involves clinical examination supplemented by imaging, typically MRI and/or CT scanning, to determine the full extent of the lesion and to evaluate for any intracranial connection. Treatment is surgical excision, which is the standard of care and is recommended to prevent recurrent infections and potential intracranial complications. The surgical approach depends on the extent of the lesion and may range from a simple elliptical excision to an open rhinoplasty or even a combined neurosurgical approach (craniotomy) if intracranial extension is present. Complete excision is essential to prevent recurrence, and outcomes are generally excellent when the cyst is fully removed.

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