以面中部感染为首发症状的儿童鼻中线囊肿及瘘管59例临床分析

Clinical analysis of 59cases of pediatric nasal dermal sinus cysts with midfacial infection as the first symptom

目的:总结以面中部感染为首发症状的儿童鼻中线囊肿及瘘管(NDSC)的临床特点及诊疗经验。方法:收集2007年1月—2021年12月就诊于北京儿童医院的59例NDSC继发额鼻眶区感染患儿的临床资料。均完善薄层CT及MRI检查,并进行全身麻醉内镜辅助下囊肿及瘘管切除术。结果:59例病例包括囊肿1例,瘘管58例。NDSC主要部位包括鼻根20例(33.9%),鼻梁34例(57.6%),鼻尖4例(6.8%),鼻尖及鼻根1例(1.7%)。病变深度包括鼻额骨浅表型6例(10.2%),鼻额骨型33例(55.9%),颅内硬膜外型19例(32.2%),颅内硬膜内型1例(1.7%)。感染灶主要部位包括内眦15例(25.4%),鼻背22例(37.3%),鼻根16例(27.1%),前额部6例(10.2%)。59例患儿中,合并其他疾病7例(11.9%),外鼻畸形4例(6.8%)。手术入路包括横行小切口12例(20.3%),纵行小切口41例(69.5%),开放式整形切口4例(6.8%),双顶冠状切口2例(3.4%)。病变范围与MRI结果均完全符合。所有患儿手术过程顺利,未行一期鼻背重建术。术后随访7~173个月(平均52.2个月),复发6例,均为鼻梁瘘管原位复发,再次手术,随访至今无复发。全部患儿外鼻无畸形,外观满意。结论:以面中部感染为首发症状的儿童NDSC感染临床少见,表现多样。早期诊断及合理化治疗对于提高治愈率至关重要。高分辨率MRI辅以CT扫描对于判断NDSC的走行,尤其是与颅内贯通情况具有重要意义。治疗目标是在彻底切除病灶的前提下尽量做到微创、个体化,并兼顾美容需求。

Objective:To review the clinical and radiological presentation and management of infected nasal dermal sinus cysts(NDSC)in children.Methods:Clinical data were collected from 59 NDSC children with secondary fronto-orbital area infection who presented to Beijing Children’s Hospital from January 2007 to December 2021.All patients underwent preoperative imaging workup,including MRI and CT.All patients underwent endoscopic excision of a NDSC under general anesthesia.Results:A total of 59 patients were included in the study,while 58 presented with a sinus,1 presented with a cyst.The main lesions of NDSC included nasal root in 20 cases(33.9%),nasal bridge in 34 cases(57.6%),nasal tip in 4 cases(6.8%),and nasal tip and nasal root in 1 case(1.7%).The depth of lesions included 6 cases(10.2%)of superficial type of nasal frontal bone,33 cases(55.9%)of nasal frontal bone,19 cases(32.2%)of intracranial epidural type,and 1 case(1.7%)of intracranial epidural type.The main sites of infection included inner canthus in 15 cases(25.4%),nasal dorsum in 22 cases(37.3%),nasal root in 16 cases(27.1%),and forehead in 6 cases(10.2%).Among 59 cases,7 cases(11.9%)were complicated with other diseases,and 4 cases(6.8%)had external nasal deformities.Surgical approaches included transverse incision in 12 cases(20.3%),minimal midline vertical incision in 41 cases(69.5%),external rhinoplasty in 4 cases(6.8%)and bicoronal incision with vertical incision in 2 cases(3.4%).The range of lesions was completely consistent with MRI results.All cases were successfully operated without one-stage nasal dorsum reconstruction.All patients were followed up from 7 to 173 months(average 52.2 months).There were 6 cases of recurrence,all of which were in situ recurrence.The operation was performed again,and no recurrence has occurred since the follow-up,No nasal deformity was noted,and cosmetic outcome were favorable for all patients.Conclusion:NDSC infection in children with midfacial infection as the first symptom is rare in clinical practice,and its manifestations are diverse.Early diagnosis and rational treatment are very important to improve the cure rate.Preoperative high resolution MRI combined with CT scanning is of great significance in judging the course of NDSC,especially the intracranial extension.The treatment goal is to achieve minimally invasive and individualized treatment under the premise of complete excision of the lesion,and take into account the cosmetic needs.