An Uncommon Case of Facial Trauma

Marilena Trozzi, Giovanni De Vincentiis, Emanuela Sitzia, Marco Carretti, Sergio Bottero
Otolaryngology—Head and Neck Surgery 2012, 147 (2): P242
Objective: Present a rare case of a massive posttraumatic nasal swelling hiding a complication of an undiagnosed nasal dermoid sinus cyst in a 3-year-old boy. Emphasize that the clinical history, careful assessment, and especially accurate imaging are essential for accurate diagnosis and the proper treatment to be applied. Method: A 3-year-old boy was admitted to our hospital because of swelling of the fronto-nasal regions following a nasal trauma occurring 5 days earlier. X-rays of the nasal bones in the lateral side were negative for fracture. Given the noteworthy facial deformation we opted for a hospitalization for further study. Results: Bone-image CT and 3D-CT revealed bone defects within the frontal skull base. MRI demonstrates that a dermoid cyst centered in a bone defect was in contact with the dura of the frontobasal area, and a dermal sinus extending to the frontonasal skin could also be detected. Only then we observed the midline pit on the nasal dorsum initially attributed to the outcomes of recent trauma. Surgical resection was performed by frontobasal craniotomy. The dermal sinus was followed subcutaneously into the orifice of the nasal skin. A small skin incision was made and the sinus was then totally removed. Conclusion: Radiological imaging is crucial for defining diagnosis, but observation of disproportion between sign and medical history that it has been possible to direct toward the correct study and the appropriate therapy to be performed.

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