Hanikeri M, Waterhouse N, Kirkpatrick N, Peterson D, Macleod I
Department of Craniofacial Surgery, Chelsea and Westminster Hospital, Chelsea, London SW10 9NH, UK.
Br J Plast Surg. 2005 Dec;58(8):1043-50. doi: 10.1016/j.bjps.2005.05.021. Epub 2005 Aug 9.
The most common congenital midline nasal masses are nasal dermoid sinus cysts (NDSC) [Hughes GB, Sharpino G, Hunt W, Tucker HM. Management of the congenital midline nasal mass--a review. Head Neck Surg 1980;2:222-33.]. Their clinical importance hinges on their potential to communicate with the central nervous system. Preoperative diagnosis of an intracranial extension allows for referral to a craniofacial team with the appropriate skills and experience for a transcranial approach. All patients with a NDSC require imaging with high resolution multiplanar MRI scans and complimentary fine cut CT scan to reveal the anatomical extent of the tract and its relationship to the anterior cranial fossa. A single-stage craniofacial approach to resection of midline NDSC extending to the anterior cranial base is effective with minimal morbidity [Yavuzer R, Bier U, Jackson IT. Be careful: it might be a nasal dermoid cyst. Plast Reconstr Surg 1999;103:2082-3; Denoyelle F, Ducroz V, Roger G, Garabedian EN. Nasal dermoid sinus cysts in children. Laryngoscope 1997;107:795-800; Rohrich RJ, Lowe JB, Schwartz MR. The role of open rhinoplasty in the management of nasal dermoid cysts. Plast Reconstr Surg 1999;104:2163-70; Rahbar R, Shah P, Mulliken JB, et al. The presentation and management of nasal dermoid-a 30-year experience. Arch Otolaryngol Head Neck Surg 2003;129:464-71; Posnick JC, Bortoluzzi P, Armstrong DC, Drake JM. Intracranial nasal dermoid sinus cysts: computed tomographic scan findings and surgical results. Plast Reconstr Surg 1994;93:745-54 [discussion 755-56]; Bartlett SP, Lin KY, Grossman R, Kratowitz J. The surgical management of orbitofacial dermoids in the pediatric patient. Plast Reconstr Surg 1993;91:1208-15.]. The cyst and tract are accessed through a combination of a nasal and transcranial approach. This allows visualisation and dissection of the tract with only a small incision on the nasal dorsum to include the cutaneous punctum when present. Transnasal endoscopic techniques have been advocated where the dermoid is located within the nasal cavity and there is little or no cutaneous involvement [Weiss DD, Robson CD, Mulliken JB. Transnasal endoscopic excision of midline nasal dermoid from the anterior cranial base. Plast Reconstr Surg 1998;101:2119-23.]. We present a review of five cases referred to our unit between 1999 and 2004 with a diagnosis of a midline nasal dermoid sinus cyst and radiological evidence of intracranial communication. All cases had a communication with the anterior cranial fossa diagnosed preoperatively and were treated surgically with a craniofacial approach. An intracranial extension was identified at operation in each case and this was confirmed on histopathology. The only significant complication resulted from an early postoperative infection, requiring re-operation. There were no recurrences and acceptable aesthetic outcomes have been observed in all cases.
最常见的先天性中线鼻部肿物是鼻皮样窦囊肿（NDSC）[休斯GB，沙皮诺G，亨特W，塔克HM。先天性中线鼻部肿物的处理——综述。头颈外科1980年；2：222 - 33。]。其临床重要性取决于其与中枢神经系统相通的可能性。术前诊断颅内扩展情况可将患者转诊至具备适当技能和经验的颅面外科团队，以便采用经颅入路。所有患有NDSC的患者都需要进行高分辨率多平面MRI扫描及辅助的薄层CT扫描成像，以显示管道的解剖范围及其与前颅窝的关系。对于延伸至前颅底的中线NDSC，采用单阶段颅面入路切除有效，且发病率极低[亚武泽尔R，比尔U，杰克逊IT。小心：可能是鼻皮样囊肿。整形重建外科1999年；103：2082 - 3；德努瓦耶勒F，迪克罗兹V，罗杰G，加拉贝迪安EN。儿童鼻皮样窦囊肿。喉镜1997年；107：795 - 800；罗里奇RJ，洛维JB，施瓦茨MR。开放式鼻整形术在鼻皮样囊肿处理中的作用。整形重建外科1999年；104：2163 - 70；拉哈尔R，沙阿P，穆利肯JB等。鼻皮样囊肿的表现及处理——30年经验。耳鼻咽喉头颈外科档案2003年；129：464 - 71；波斯尼克JC，博托卢齐P，阿姆斯特朗DC，德雷克JM。颅内鼻皮样窦囊肿：计算机断层扫描结果及手术效果。整形重建外科1994年；93：745 - 54[讨论755 - 56]；巴特利特SP，林KY，格罗斯曼R，克拉托维茨J。小儿眼眶面部皮样囊肿的外科处理。整形重建外科1993年；91：1208 - 15。]。通过鼻入路和经颅入路相结合来显露囊肿和管道。这样仅在鼻背做一个小切口（如有皮肤小孔则将其包括在内）就能观察和分离管道。对于皮样囊肿位于鼻腔内且几乎没有或没有皮肤受累的情况，有人主张采用经鼻内镜技术[魏斯DD，罗布森CD，穆利肯JB。经鼻内镜从前颅底切除中线鼻皮样囊肿。整形重建外科1998年；101：2119 - 23。]。我们回顾了1999年至2004年间转诊至我们科室的5例诊断为中线鼻皮样窦囊肿且有颅内相通影像学证据的病例。所有病例术前均诊断为与前颅窝相通，并采用颅面入路进行手术治疗。术中在每例中均发现颅内扩展，组织病理学检查予以证实。唯一的严重并发症是术后早期感染，需再次手术。所有病例均无复发，且观察到了可接受的美学效果。
