Management of Pediatric Nasal Dermoids

Objective: In this study, we review our experience with the management of pediatric nasal dermoids with a direct excision technique.

Methods: We performed a retrospective chart review at a tertiary care, pediatric hospital with patients younger than 18 years who were diagnosed with and surgically treated for nasal dermoid between January 1, 2000 and July 31, 2011. Adequate documentation of pathologic diagnosis, radiographic findings, operative notes, and follow-up examinations were necessary for inclusion in the study.

Results: Twenty-five patients were identified who met the inclusion criteria. The average age at the time of surgery was 45.7 months. Twenty-four (96%) of the patients were approached with direct excision of the lesion. In two of the cases, either an operating microscope or a rigid endoscope was used to aid in visualization of the dermoid tract to ensure adequate excision. Closure in all but two (4%) was achieved tension free with direct approximation. The other two cases required adjacent tissue transfer for adequate cosmetic closure. Only one case—the patient with the largest dermoid encountered in the study group, with prenasal and extracranial extent and largest dimension of 3.0 cm—was approached using an external rhinoplasty approach. Three cases (12%) were identified as having intracranial extension, but intraoperative, neurosurgical consultation was only required in one case for repair of a cerebrospinal fluid (CSF) leak. Complications occurred in two cases (4%). One was an immediate postoperative hematoma, which required wound re-exploration. The other complication was a CSF leak, which was identified and repaired intraoperatively by neurosurgery. The average length of hospital stay was 2.4 days. No recurrences were encountered with an average follow-up of 51.6 months.

Conclusion: Directed excision of nasal dermoids in pediatric patients affords excellent exposure and visualization, with or without the use of an endoscope or operating microscope. Reduced elevation and manipulation of surrounding tissues occurs, compared with other approaches, such as external rhinoplasty or craniotomy approaches. Short recovery times and minimal hospital stay can be expected. Complication rates, recurrences, length of hospital stay, and cosmetic outcomes are very favorable.