Nasal dermoid sinus cysts (NDSCs) are rare neoplasms in the median line of the nasofrontal area. Unlike other dermoid cysts, a NDSC can manifest as a cyst, sinus, or fistula, and may extend intracranially. Nasal dermo...Nasal dermoid sinus cysts (NDSCs) are rare neoplasms in the median line of the nasofrontal area. Unlike other dermoid cysts, a NDSC can manifest as a cyst, sinus, or fistula, and may extend intracranially. Nasal dermoid cysts usually present at birth and are commonly diagnosed by 3 years of age. An incidentally detected nasal dermoid cyst in an adult patient is extremely rare. In this case, a 23-year-old female with a history of intermittent serous thick discharge from a pit in the nasal columella since early childhood. Examination of the nasal cavity showed mild septal deviation to the left side, dorsal hump, wide nasal bone, a small pit-sinus at the columella, over projected nose, and wide bulbous down rotated nasal tip. The findings were suggesting nasal dermoid cyst, so a magnetic resonance imaging (MRI) was done for the patient to confirm the diagnosis. The MRI findings showed that there are 3 small cysts at the nasal septum anteriorly with a small fistula connecting the anterior inferior 2 cysts with no involvement to the intracranial cerebrospinal fluid (CSF) space. During the surgery, an open rhinoplasty approach was used. The trans-columellar incision was made around the fistula, and the tract was identified using a lacrimal probe and methylene blue. The dissection around the tract was continued until the sac was identified in the area of the membranous septum, and it was removed and sent for histopathology. The surgery then continued in a regular full rhinoplasty fashion. In conclusion, dermoid cyst of the nasal septum is a rare congenital lesion, especially in adults. After a thorough history taking and physical examination, a preoperative high-resolution axial and coronal CT and/or MRI is essential for diagnostic and operative planning. The treatment of choice for nasal dermoid cysts is complete surgical excision with clear margins. Surgical strategies usually depend on the location and extent of the lesion. Recurrence is uncommon and often easily managed.展开更多
Silver nitrate is sometimes used as a means of chemicalcauterization for control of minor bleeding and management of hypergranulation tissue following bedside head and neck procedures. There are only few reports avail...Silver nitrate is sometimes used as a means of chemicalcauterization for control of minor bleeding and management of hypergranulation tissue following bedside head and neck procedures. There are only few reports available on the imaging appearance of silver nitrate and its potential to mimic a foreign body. We report a case of a patient presenting with dysphagia, odynophagia, and fever following dental work who had a peritonsillar incision and drainage for treatment of a deep neck space infection. During the procedure, silver nitrate was applied to halt the bleeding. Patient was subsequently transferred to another institution. Since the patient was not showing significant clinical improvement on antibiotic therapy, a computed tomography(CT) scan was performed demonstrating a hyperdense structure lodged in the pharyngeal mucosal space in the oropharynx and soft palate that was mistaken for a foreign body such as bone. Silver nitrate can have density similar to bone but does not have the normal architecture of bone with cortex and marrow on CT. Familiarity with the appearance of silver nitrate on CT, lack of bone architecture, and proper documentation and communication of the use of silver nitrate to the consultant radiologist and medical personnel could help avoid misdiagnosis and potentially unnecessary surgical exploration.展开更多
文摘Nasal dermoid sinus cysts (NDSCs) are rare neoplasms in the median line of the nasofrontal area. Unlike other dermoid cysts, a NDSC can manifest as a cyst, sinus, or fistula, and may extend intracranially. Nasal dermoid cysts usually present at birth and are commonly diagnosed by 3 years of age. An incidentally detected nasal dermoid cyst in an adult patient is extremely rare. In this case, a 23-year-old female with a history of intermittent serous thick discharge from a pit in the nasal columella since early childhood. Examination of the nasal cavity showed mild septal deviation to the left side, dorsal hump, wide nasal bone, a small pit-sinus at the columella, over projected nose, and wide bulbous down rotated nasal tip. The findings were suggesting nasal dermoid cyst, so a magnetic resonance imaging (MRI) was done for the patient to confirm the diagnosis. The MRI findings showed that there are 3 small cysts at the nasal septum anteriorly with a small fistula connecting the anterior inferior 2 cysts with no involvement to the intracranial cerebrospinal fluid (CSF) space. During the surgery, an open rhinoplasty approach was used. The trans-columellar incision was made around the fistula, and the tract was identified using a lacrimal probe and methylene blue. The dissection around the tract was continued until the sac was identified in the area of the membranous septum, and it was removed and sent for histopathology. The surgery then continued in a regular full rhinoplasty fashion. In conclusion, dermoid cyst of the nasal septum is a rare congenital lesion, especially in adults. After a thorough history taking and physical examination, a preoperative high-resolution axial and coronal CT and/or MRI is essential for diagnostic and operative planning. The treatment of choice for nasal dermoid cysts is complete surgical excision with clear margins. Surgical strategies usually depend on the location and extent of the lesion. Recurrence is uncommon and often easily managed.
文摘Silver nitrate is sometimes used as a means of chemicalcauterization for control of minor bleeding and management of hypergranulation tissue following bedside head and neck procedures. There are only few reports available on the imaging appearance of silver nitrate and its potential to mimic a foreign body. We report a case of a patient presenting with dysphagia, odynophagia, and fever following dental work who had a peritonsillar incision and drainage for treatment of a deep neck space infection. During the procedure, silver nitrate was applied to halt the bleeding. Patient was subsequently transferred to another institution. Since the patient was not showing significant clinical improvement on antibiotic therapy, a computed tomography(CT) scan was performed demonstrating a hyperdense structure lodged in the pharyngeal mucosal space in the oropharynx and soft palate that was mistaken for a foreign body such as bone. Silver nitrate can have density similar to bone but does not have the normal architecture of bone with cortex and marrow on CT. Familiarity with the appearance of silver nitrate on CT, lack of bone architecture, and proper documentation and communication of the use of silver nitrate to the consultant radiologist and medical personnel could help avoid misdiagnosis and potentially unnecessary surgical exploration.
