title: Access to the crista galli and the foramen caecum in nasal dermal sinus cysts - lessons learned in a single tertiary care centre.
abstract: OBJECTIVE
  Several surgical techniques have been suggested for the treatment of nasal dermal sinus cysts (NDSC). We have used several different techniques and have developed a minimally invasive approach. The aim of this study is to describe the evolution to this approach and compare the results with those achieved with our experience of more traditional techniques.
  
  
  RESULTS
  A retrospective data collection of patients with NDSC presenting to our clinic between 1998 and 2012 was performed. We initially performed external approaches as outlined elsewhere. With an increasing number of young children requiring surgery, the technique was modified to a less invasive form. This new approach starts with mobilisation of the pit via a tiny skin incision. An open rhinoplasty approach is used to follow the fistula on the nasal bone. Once the fistula passes underneath the nasal bone, an endoscopic endonasal approach is used. Following the fistula cranially, the area of the foramen caecum can be identified.
  
  
  RESULTS
  Twelve out of 15 patients (80%) were treated surgically. The transfacial, coronal subcranial and minimally invasive approach was used in 3 (25%), 4 (33%) and 5 patients (42%), respectively. Radical resection was achieved in all patients. Cosmetic problems were present in all patients undergoing a transfacial and in half of the patients after the coronal subcranial approach. Patients treated by the minimally invasive technique remained without sequelae.
  
  
  CONCLUSIONS
  The minimally invasive approach enables a perfect exposure of the fistula up to the crista galli and provides less morbidity and better cosmetic results than the transfacial and subcranial approach.
authors: Department of Otorhinolaryngology, University Hospital of Zurich, Switzerland. domenic.vital@bluewin.ch
authors: D
authors: D
authors: Vital
authors: N
authors: N
authors: Krayenbuhl
authors: O
authors: O
authors: Bozinov
authors: D
authors: D
authors: Holzmann
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003560:Cysts / Q000175:diagnosis / Q000601:surgery*; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D009668:Nose Diseases / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods*; D016136:Spina Bifida Occulta / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome