2025 Proffered Presentations
S387: AN ALGORITHMIC APPROACH TO RESECTION OF NASAL DERMOIDS WITH INTRACRANIAL EXTENSION
Jeffery May, MD1; Travis Clarke, MD1; Sanjeet Rangarajan, MD2; L Madison Michael 2nd, MD1; Anas Eid, MD1; 1University of Tennessee Health Science Center - Memphis; 2University Hospitals Otolaryngology
Introduction: This study introduces a comprehensive algorithmic approach for treating nasal dermoids with intracranial extension. The primary goals of this algorithm are to achieve complete resection of the dermoid while minimizing surgical morbidity. By providing surgeons with a clear, structured decision-making process, the algorithm aims to optimize surgical outcomes and ensure patient safety.
Methods: The development of this algorithm involved an extensive review of current literature on surgical approaches for pediatric nasal dermoids. The key factors considered in the algorithm included clinical findings on endoscopic exam, intracranial extent, intranasal sinus tract, patient age, nasal tip/dorsum involvement and reconstructive considerations.
Results: The surgical approaches reviewed included the endoscopic endonasal approach, the modified open rhinoplasty, and direct excision. The endoscopic endonasal approach is recommended for cases with limited intracranial extension and favorable anatomical conditions. This minimally invasive technique offers reduced morbidity, shorter hospital stays, and minimal scarring. When endoscopic access is insufficient, a modified open rhinoplasty can be employed. This approach provides enhanced visualization and assists with reconstructive efforts, especially in cases where the nasal dorsum or tip would be compromised by resection. For cases involving extensive intracranial involvement, a direct excision with craniotomy may be necessary to ensure complete resection. The algorithm outlines criteria for selecting this approach while weighing possible morbidity and longer recovery times.
Conclusion: A discernible gap exists in the literature regarding the optimal surgical approach for nasal dermoids with intracranial extension. While open approaches (e.g. craniotomy) grant comprehensive exposure, they come with greater morbidity, length of hospital stay, and a visible scar. This study proposes the first algorithmic approach to surgical planning for nasal dermoids, accounting for intracranial extent, patient age, and anatomical constraints.