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Published on: July 5, 2021
[Management of nasal fistulas with intracranial extension]
S Dazert1, K Schmieder, A Gurr
1Universitätsklinik für Hals-Nasen-Ohrenheilkunde und Kopf- und Halschirurgie, Ruhr-Universität Bochum, St. Elisabeth-Hospital, Bochum, Germany. Stefan.Dazert@ruhr-uni-bochum.de
Background:
Medial nasal fistulas are rare congenital malformations that mostly become obvious by recurrent infections such as secretion from the fistula opening or swelling of the nasal tissues. In rare cases, these fistulas may extend intracranially with meningeal irritations.
Patient Presentation:
Three patients with medial nasal fistulas were operated during the last two years in our department. In two children, the fistulas ended at the glabella. In one older boy, the fistula revealed an intracranial extension. In the last case, a combined rhino- and neurosurgical approach was applied to perform a complete resection of the fistula.
Discussion:
During the second embryonic month of facial development, the medial nasal processes approach each other with a fusion of their epithelial covering that completely disappears during later stages. If parts of this epithelial fusion zone persist, epithelial remnants may develop into nasal fistulas or dermoids. The adequate therapy of these nasal malformations consists of a complete surgical removal.
Insights
Medial nasal fistulas are rare congenital conditions often causing infections. Complete surgical removal is the recommended treatment for these nasal malformations.
Area of Science:
- Craniofacial surgery
- Pediatric surgery
- Congenital malformations
Background:
- Medial nasal fistulas are rare congenital malformations.
- They often present with recurrent infections like nasal discharge or swelling.
- Rarely, these fistulas can extend intracranially, causing meningeal irritation.
Purpose of the Study:
- To describe the clinical presentation and management of medial nasal fistulas.
- To highlight the embryological origin of these malformations.
- To emphasize the importance of complete surgical resection.
Main Methods:
- Surgical case review of three patients with medial nasal fistulas over two years.
- Detailed description of fistula termination (glabella or intracranial).
- Application of a combined rhino- and neurosurgical approach for intracranial extension.
Main Results:
- Two patients had fistulas terminating at the glabella.
- One patient had an intracranial extension requiring a combined surgical approach.
- Complete resection was achieved in all cases.
Conclusions:
- Medial nasal fistulas arise from persistent epithelial remnants during facial development.
- Complete surgical excision is the definitive treatment for nasal fistulas and dermoids.
- A multidisciplinary approach may be necessary for complex intracranial extensions.
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