Nasal dermoid cysts are saclike growths that are present at birth and usually sit over the bridge of the nose. They may be completely unconnected with the nasal structures, within the nose or both. Sometimes, they have an associated passage that leads to the skin of the nose and this may discharge from time to time.
Dermoid cysts grow slowly and are not tender unless ruptured or infected. Occasionally, the cysts have an internal tract that leads up to the coverings of the brain and in this case, repeated infections may lead to meningitis. Dermoid cysts can contain structures such as hair, fluid, teeth or skin glands. Children of any race or gender can develop a nasal dermoid cyst.
How do nasal dermoid cysts develop?
They develop early in pregnancy, when skin and skin structures become trapped while the baby is developing in the womb. Nasal dermoid cysts can not be prevented. Nothing done, or not done, during pregnancy could have caused them.
How are they diagnosed?
How can nasal dermoid cysts be treated?
Surgical removal remains the treatment of choice. Without treatment, the cyst will typically continue to grow and may cause problems with repeated infection.
What happens before the operation?
Parents receive information about how to prepare their child for the operation in their admission letter. The doctors will explain the operation in more detail, discuss any worries families may have and ask them to give permission for the surgery by signing a consent form. Another doctor will also visit to explain about the anaesthetic. If the child has any medical problems, particularly allergies, the doctors should be told about these. Any medicines the child is currently taking should also be brought in.
What does the operation involve?
The nasal dermoid cyst is removed in an operation carried out under general anaesthetic. The surgeon makes an incision (cut) in the skin of the nose, either around any skin tract or in some cases underneath the nose. The cyst then removed carefully so that none of the cyst behind. The incision is closed using stitches.
Are there any risks?
Every operation carries some risk of infection and bleeding. After removal of the cyst, sometimes a small depression is left in the skin. In our experience this fills out over the course of a few months and is not usually a problem. Every anaesthetic carries a risk, but this is very small. Modern anaesthetics are very safe and the child's anaesthetist is a very experienced doctor who is trained to deal with any complications.
What happens afterwards?
After the operation, the child will return to the ward to wake up fully from the anaesthetic. Once he or she feels comfortable and has had a drink, they will be able to go home. The surgeon may recommend a short course of antibiotics.
The child should be given pain relief medicines such as paracetamol or ibuprofen according to the instructions on the bottle. If the surgeon has prescribed a course of antibiotics, the child should finish the entire course. The stitches closing the incision may be removed after a week. This will involve a return visit to GOSH to have them removed under sedation, or general anaesthetic if necessary.
The child will need to come back to GOSH for a check up appointment six weeks after the operation. We will send details of this appointment in the post. We suggest that the child avoids rough and tumble play, sport and swimming until after this appointment.
What is the outlook for children with nasal dermoid cyst?
If the dermoid cyst is diagnosed early and removed completely, the prognosis is good. If the nasal dermoid cyst is not completely removed, it is very likely that it will come back and may become infected. Repeated infections, particularly if there is a passage leading to the brain coverings, could increase the risk of meningitis.