Nasal dermoid sinus cysts in adults

Nasal dermoid sinus cysts (NDSC) are rare congenital lesions that most frequently present in children, but have been reported in adults. This article reviews adult (more than 16 years of age) nasal dermoid sinus cysts as they present, their radiological investigation, surgical approach and outcome. Thirty-eight previously published cases are reviewed, to which a further six cases are added. All 44 cases are tabulated and reviewed. The risk of intracranial extension is 27.5 per cent, especially men with a dermal sinus. Recurrences are likely if the NDSC is not completely excised. Curative treatment is surgical. It is recommended that all adults who present with a dermal cyst and/or sinus in the region of the nasal dorsum should be investigated by computed tomography (CT) and/or magnetic resonance (MRI). This is to delineate deep tissue involvement and to exclude a possible associated intracranial extension, prior to recommending surgical excision.     

Congenital dermoid cysts of the tongue

A case of large dermoid cyst in the tongue in a 3 1/2-month-old child is presented. Histologically it was an epidermoid cyst. Typically corresponding cysts are diagnosed during the first four months of life. When the cyst was punctured, some keratin escaped and caused a granulation tissue reaction with granulocytes between the muscles of the tongue. The cyst was treated by marsupialization. No abnormality in the shape or function of the tongue was seen after 24 months.     

Management of congenital lingual dermoid cysts

Background

Lingual dermoid cysts are squamous epithelial-lined cavities with variable numbers of skin adnexae in the capsule and are rare entities in the head and neck. We discuss the presentation, possible aetiologies and the surgical management of these lesions and report on the ninth lingual dermoid cyst as an illustrative example, the first to be excised by laser.

Methods

An extensive literature search was undertaken. We present the case of a 4-month-old di-zygotic twin girl with a firm midline anterior tongue dermoid cyst. Its extent was defined by magnetic resonance imaging. The cyst was excised using the CO₂ laser via an extended median sagittal glossotomy approach.

Results

Lingual dermoid cysts most commonly present in early childhood or adolescence and are located in the anterior two thirds of the tongue. Eight lingual dermoid cysts have been reported, all of which were surgically excised, using varying techniques, and no recurrences have been reported.Our patient recovered well and was extubated immediately post-operatively. However, feeding was delayed for 48 h post-operatively due to pain, requiring opiate analgesia. The tongue healed completely with only a small indent in the tip.

Conclusions

Treatment of these lesions consists of complete surgical excision. We propose that the midline sagittal glossotomy incision using the CO₂ laser offers surgical precision, superior haemostasis and wound healing and minimal post-operative oedema. The involvement of the sensitive tongue tip in this approach may be its one drawback, however this may be compensated for with appropriate post-operative analgesia.     

Branchial cysts,sinuses and fistulae

Branchial cysts, sinuses and fistulae are reviewed with special reference to their origin, clinical features, pathology and treatment. The material consists of a survey of over 700 recorded cases, a series of 90 cases studied in retrospect with special reference to the pathology, and a personal experience of 42. It is suggested that a proportion of ‘branchial cysts’ do not arise from the branchial apparatus, but possibly may do so from epithelial inclusions in lymph nodes. It is acceptcd that branchial sinuses develop from the branchial apparatus, but there is little proof that such an entity as ‘branchial fistula’ exists.     

Congenital cervical cysts, sinuses and fistulae

Congenital cervical anomalies are important to consider in the differential of head and neck masses in children and adults. These lesions can present as palpable cystic masses, infected masses, draining sinuses, or fistulae. Thyroglossal duct cysts are most common, followed by branchial cleft anomalies, dermoid cysts, and more rarely median cervical clefts. Other topics discussed include median ectopic thyroid, cervical teratomas, and branchiootorenal syndrome. Appropriate diagnosis and management of these lesions requires a complete understanding of their embryology and anatomy. Correct diagnosis, resolution of infectious issues before definitive therapy, and complete surgical excision are essential to prevent recurrence.     

Branchial cysts, sinuses and fistulae.

Branchial cysts, sinuses and fistulae are reviewed with special reference to their origin, clinical features, pathology and treatment. The material consists of a survey of over 700 recorded cases, a series of 90 cases studied in retrospect with special reference to the pathology, and a personal experience of 42. It is suggested that a proportion of 'branchial cysts' do not arise from the branchial apparatus, but possibly may do so from epithelial inclusions in lymph nodes. It is accepted that branchial sinuses develop from the branchial apparatus, but there is little proof that such an entity as 'branchial fistula' exists.     

Nasal dermoid cyst: diagnosis and management of five cases

Five cases of nasal dermoid cyst are presented. Three out of five cases were settled during childhood. Three presented a mass with a hole on the external nose with recurrent local infections. One case was wrongly referred for a dacryocystitis. The first one was detected during an infection of the cerebral extension and frontal abscess was assessed by CT scan and MRI. Two patients had other associated congenital abnormalities: hypotrophy of the external ear in one case, multiples malformations in an other. Adequate exposure and cosmetic results are sometimes contradictory to define the best surgical approach. Dermoid cysts and sinuses must be completely removed to prevent recurrence. External rhinoplasty and bicoronal approach are the main procedures for removing these lesions.     

Sublingual contiguous thyroglossal and dermoid cysts in a neonate.

Thyroglossal duct cysts and dermoid cysts are two distinct lesions which can occur in the midline of the head and neck region. Different embryologic explanations for these two lesions have traditionally been accepted. Recent evidence, however, hints at an association between them. We present here a case in which both of these cysts occurred together in an unusual anatomic location, along with a discussion of the possible relationship between these two pathologic entities.