This is an interesting case report of a patient with midline dermoid cyst involving the nasal cavity and frontal sinus.
History:
25 year old male patient came with complaints of discharging sinus involving the middle of the dorsum of nose - 15 years
Gave H/O surgery for swelling over nose - 10 years back ? Incision & drainage
On examination:
As shown in the photograph there was a midline sinus over the dorsum of nose. Serous discharge could be seen coming out.
Another sinus could also be seen over the right side of forehead over the frontal sinus area. Discharge could be seen coming out.
The discharge from the forehead was foul smelling in nature.
Imaging:
See the attached MRI image files.
The sinus was approached via an intercartilagenous incision. The dermoid tract was identified and was found
filled with hair. The same tract could be seen extending to the interior of right frontal sinus. For better visibility
the frontal sinus anterior table was opened via Lynch Howarth incision on the right side. The frontal sinus was
found filled with hair and purulent material. The same was removed. The frontal sinus mucosa was curetted out
and the sinus cavity was obliterated with fat.
Discussion:
A dermoid cyst is defined as a cystic teratoma containing developmentally mature skin complete with hair follicles and
sweat glands. In some cases long hair will also be seen. Sometimes teeth, bone, and nails could also be found inside. In this type of midline lesion the presence of enchaphalocele should always be ruled out. That is the reason for MRI scan in this patient.