An Unusual Mid-Line Nasal Mass in a Child: A Case Report

Abstract

Congenital midline nasal masses are rare anomalies with a prevalence of 1 in 20,000 to 40,000 births. These masses include nasal glioma, dermoid cyst, lipoma, hemangioma, and encephalocele. Timely diagnosis and appropriate surgical management are essential for optimal outcomes. We report the case of a 3-year-old girl presenting with a firm, non-fixed, slightly erythematous midline nasal mass, which was present at birth but increased in size over time, and a right nasal encephalocele. Radiological evaluation, including computed tomography (CT) and magnetic resonance imaging (MRI), confirmed the presence of both lesions with no connection between them. Initially, the right nasal encephalocele was endoscopically repaired. Subsequently, an incision was made in the midline nasal dorsum, and the nasal dorsal mass was successfully excised. Postoperative recovery was uneventful, and the patient was discharged without complications. The pathological examination of the excised nasal dorsum sample revealed a dark-colored, thick, malodorous material and hair follicles on macroscopic inspection. Microscopic inspection revealed the presence of skin appendages and hair follicles, findings consistent with a dermoid cyst. This case report highlights the co-occurrence of an encephalocele and a dermoid cyst, emphasizing the importance of thorough radiographic evaluation for accurate diagnosis. The surgical management, a novel technique, included skin closure using an advancement flap without grafting, resulting in a faster patient recovery time and a reduced hospital stay.