Imaging and surgical approach of nasal dermoids.
OBJECTIVE
Determine the most accurate and cost effective radiographic evaluation for nasal dermoids. Determine the best surgical approach for excision of nasal dermoids.


METHODS
Retrospective chart review.


METHODS
Division of Pediatric Otolaryngology, Children's Hospital and Health Center, San Diego, California.


METHODS
All patients with nasal dermoids evaluated and treated from 1990 to 2000.


METHODS
Preoperative radiographic evaluation and surgical excision.


METHODS
Accuracy of CT and MRI correlated with surgical findings and results.


RESULTS
Ten patients were identified with the diagnosis of nasal dermoid. The age at diagnosis ranged from 0 to 24 months, with a mean of 3 months. Six children presented with masses located at the glabella, three patients presented with masses located at the nasal dorsum and one presented with a mass at the nasal tip. Six children underwent a computed tomogram with contrast of the head. Seven children underwent a MRI study of the head. Three children underwent an initial CT followed by MRI. Twenty percent of children were found to have intracranial extension. CT scan accurately diagnosed intracranial extension in one case, was indeterminate in a second case and falsely positive in a third case. MRI correctly diagnosed intracranial extension in two cases and had no false positive or false negative results. No children were found to have associated intracranial anomalies. In the early years of the review, a simple excision was made over the mass with blunt and sharp dissection for removal. (An external rhinoplasty incision is now used with better exposure and improved cosmetic results.) In cases with intracranial communication, a combined approach of external rhinoplasty and craniotomy was used.


CONCLUSIONS
MRI alone is the most cost effective and accurate means of evaluating nasal dermoids and is essential for preoperative planning. The surgical approach of choice is external rhinoplasty for both cosmetic reasons and exposure of nasal dermoids with and without intracranial extension.
Bloom
David C
DC
Division of Pediatric Otolaryngology, Children's Hospital and Health Center, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 200, San Diego, CA 92134-2200, USA. dcbloom@hotmail.com
Carvalho
Daniela S
DS
Dory
Christopher
C
Brewster
Douglas F
DF
Wickersham
Jean K
JK
Kearns
Donald B
DB
D002675:Child, Preschool; D003362:Cost-Benefit Analysis / Q000191:economics; D003399:Craniotomy / Q000191:economics; D003884:Dermoid Cyst / Q000175:diagnosis* / Q000191:economics / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000191:economics; D008297:Male; D009669:Nose Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000191:economics; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000191:economics