Pituitary and Skull Base Surgery Center

Patient Stories | Miller and Nasal Dermoid Cyst

Taking the Road Less Traveled: Better Treatment for Miller’s Nasal Dermoid Cyst

When Miller was just 8 months old, an unusual, pimple-like spot appeared on his face.

“Everyone told us it was just baby acne,” said his mom, Lauren, who lives with her family in Georgia. “But I wasn’t convinced.”

Trusting her instincts, Lauren took Miller to his pediatrician, who shared her concerns. She sent them to an ear, nose and throat (ENT) specialist in Atlanta, who immediately recognized Miller’s mysterious spot as a nasal dermoid cyst.

Nasal dermoid cysts are rare. They develop in the skull base during prenatal growth. As the nose forms, the cyst grows into a barbell shape that runs along the nasal bone and cartilage. While not cancerous, these cysts don’t go away on their own. Without treatment, they can lead to serious complications.

An Unthinkable Procedure

Miller already had an upcoming appointment with a craniofacial specialist to address other issues along his midline (center of the body). After further evaluation and an MRI, the doctor delivered devastating news to Lauren and her husband, Jamaal—Miller would need a craniotomy to remove the cyst.

A craniotomy is a major surgical procedure that involves removing part of the skull to access the brain. It would leave Miller with a large scar across his face and scalp, followed by a long recovery.

“We couldn’t wrap our heads around it,” Lauren said. “I couldn’t believe this was the treatment approach for a little bump on his nose. There had to be another way.”

Desperate for Another Option

Unable to sleep, Lauren and Jamaal desperately searched for alternative solutions. During their research, they came across an article mentioning Jesse Skoch, MD, a pediatric neurosurgeon at Cincinnati Children’s.

Dr. Skoch and other neurosurgeons at Cincinnati Children’s are among the few in the nation to offer a minimally invasive treatment for nasal dermoid cysts. The technique only requires a small incision at the tip of the nose and uses endoscopic tools to remove the cyst. As a result, patients experience minimal swelling and scarring, a short hospital stay and a quick recovery at home.

Feeling hopeful, Lauren quickly scheduled a consultation with experts in the Pituitary and Skull Base Surgery Center at Cincinnati Children’s. However, Miller’s cyst was beginning to swell. The craniofacial specialist in Atlanta urged them to proceed with craniotomy surgery that week to prevent complications like meningitis. Before they could make a decision, the whole family came down with the stomach flu.

“I remember thinking it was a sign we shouldn’t go to Cincinnati Children’s,” Lauren said. 

But Jamaal reminded her of all the work they had put into their research and careful planning. Health and confidence restored, the family set off for Cincinnati.

Clarity at Cincinnati Children’s

During their visit to Cincinnati Children’s, Lauren and Jamaal met with the full treatment team to discuss the minimally invasive approach. Their team included neurosurgeon Smruti K. Patel, MD, plastic surgeon Brian S. Pan, MD, and otolaryngologist (ENT) Alessandro de Alarcon, MD.

Lauren remembered their meeting with Dr. Patel: “We had so many questions, but she never rushed us. She took the time to walk us through every possible scenario and, in the end, made us feel much more comfortable.”

Lauren and Jamaal agreed to hold off discussing the consultation until they got home. Instead, they each wrote down where they felt Miller should have his surgery. When they compared answers, their decision was clear: Cincinnati Children’s.

Pivoting in the Moment

A few months later, the family returned to Cincinnati for Miller’s surgery. He had another MRI, which revealed that the cyst was no longer fully extending up into the brain. Not wanting to get their hopes up just yet, Lauren and Jamaal anxiously awaited the outcome of the surgery.

During the procedure, Miller’s surgeons discovered a second, smaller cyst between his nostrils that was connected to the main cyst. Though it hadn’t appeared on any scans, the team quickly adapted. They made another small incision below his nose to remove it.

“Nasal dermoid cyst cases aren’t always straightforward,” Dr. de Alarcon explained. “But because we have all the right people there and all the right tools, we can pivot in the moment and still complete the surgery.”

He added that with every procedure, they discover new techniques to make their approach more efficient.

After nine and a half hours, Dr. Patel returned with good news: the team successfully removed the entire cyst. And remarkably, the opening leading into Miller’s brain had closed on its own.

“There really is such value in having a team approach to this procedure,” Dr. Patel said. “If Miller just had a neurosurgeon or plastic surgeon seeing him individually, they might not have picked up and put together the unique pieces of his case.”

A Brave Little Lion

Miller had a short, one-night stay in the hospital before bouncing back with his usual energy. Lauren said he was running around like nothing had ever happened.

“A quick recovery makes all the difference in the world,” Dr. Pan said. “Even though we had to make two small incisions in Miller’s case, both areas healed nicely over time. The incision under his nose will be camouflaged as he grows.”

Lauren and Jamaal had worried about Miller’s scars after surgery. Back at home, they were amazed to see how well he healed.

“I couldn’t believe what Dr. Pan had done,” Lauren said. “Some days, you don’t even notice his scars.”

Today, Miller is a fearless adventurer and a proud new big brother. He is always eager to climb trees and explore the outdoors. Lauren and Jamaal call him their “little lion”—a name that perfectly captures his immense courage.

Finding Trust in Expert Hands

“When families come to us for new, innovative procedures, I explain that we might not have all the answers right away,” Dr. Patel said. “But I’m here to build a relationship and explain things in ways they understand. I want to ensure they trust us and feel confident about their care.”

Lauren and Jamaal always knew Miller was in good hands.

“From the surgeons to the front desk staff, everyone at Cincinnati Children’s was so responsive and helpful,” Lauren said. “They treated Miller like their own child. We know we made the right choice for his care.”

(Published March 2025)