What is a Nasal Dermoid Cyst?
Nasal dermoid cysts are very different from other dermoid cysts due to their location and barbell shape. These rare cysts need care from a pediatric neurosurgeon.
A nasal dermoid cyst begins in the skull base during prenatal development. As the nose forms, the round lump remains in place. As it grows, a tube forms and extends away from the round lump toward the tip of the nose. Eventually, another round lump forms at the end of the tube. The result is a barbell-shaped cyst that runs along the nasal bone and nasal cartilage.
To successfully treat a nasal dermoid cyst, the entire structure must be removed surgically. If dermoid cells remain in place, the cyst can grow back.
Nasal Dermoid Cyst Symptoms
Nasal dermoid cysts are sometimes missed or misdiagnosed. Telltale signs on the tip of the nose include a:
- Reddish spot
- Small persistent or enlarging bump or pimple
- Tiny black spot
- Small opening in the skin that may leak milky fluid
If the nasal dermoid cyst is left untreated, it may create an opening at the tip of the nose. The child may develop an infection either on the nose or as meningitis. Another risk is that the cyst can push into the brain at the skull base.
Nasal Dermoid Cyst Diagnosis
Most nasal dermoid cysts are diagnosed in childhood before the age of five.
If the pediatrician believes your child may have a nasal dermoid cyst, the next step is to see a pediatric plastic surgeon, neurosurgeon or ear, nose and throat (ENT) surgeon. The specialist will examine your child and order imaging tests to learn more. Imaging can include a computed tomography (CT) scan, magnetic resonance imaging (MRI) or both.
Nasal Dermoid Cyst Removal
Removing a nasal dermoid cyst can involve major surgery. This type of surgery is effective but very invasive. The surgeon must remove part of the nasal bone to access some of the dermoid cyst. They must remove pieces of the skull to access the rest of the cyst. Patients have a lot of swelling around the eye, and must stay in the hospital for several days. Afterward, they have a large scar on the scalp.
Pediatric neurosurgeons at a small number of pediatric hospitals, including Cincinnati Children’s, offer a minimally invasive alternative using endoscopic techniques.
During this surgery, a plastic surgeon makes the incision (cut) at the tip of the nose and removes part of the cyst. The next step is to extend an endoscope (a thin, tube-shaped camera) along the nasal bone toward the skull base. The neurosurgeon and an ear, nose and throat (ENT) surgeon insert tiny surgical tools through the nose. They use them to remove the rest of the cyst (the tube and the round lump near the skull base). Advanced imaging helps the neurosurgeon see the cyst and nasal structures throughout the surgery.
This approach results in very little swelling, minimal scarring, an overnight hospital stay and a brief recovery period at home.
Nasal Dermoid Cyst Prognosis
After a nasal dermoid cyst is removed with surgery, it is unlikely to grow back.
