Two Presentations of Neuroglial Heterotopias With Cleft Palate

Neuroglial heterotopias, commonly known as nasal gliomas, are rare masses composed of brain tissue located outside the cranial vault. These masses are composed of dysplastic glial cells that have lost their intracranial connections and can present as extranasal, intranasal, or mixed masses. They are thought to result from incomplete closure of the anterior fontanelle between the nasal and frontal bones, which can result in an irregular connection between embryonic ectoderm and neuroectodermal tissue. Although the presentation of a neuroglial heterotopia in a child is uncommon, even more notable is the finding of neuroglial heterotopias visible from a concurrent cleft palate, as this can present additional difficulties in future cleft palate repair and mass excision. Presented in this report are two cases of neuroglial heterotopia found simultaneously with cleft palate. Although these lesions are typically considered benign growths, unmanaged neuroglial heterotopias can result in improper craniofacial development, leading to cosmetic complications and airway obstructions. For accurate diagnosis, thorough histological identification of the embryological tissue origins after surgical biopsy should be performed. Although neuroglial heterotopias and other masses of the nasopharynx, such as teratomas, have similar treatment methods (e.g., surgical resection), detailed histological evaluation of tissue biopsies allows physicians to properly manage cases such as these post-treatment. Early surgical removal of neuroglial heterotopias is encouraged to minimize nasal and craniofacial distortion early in development and to slow or prevent further growth of the lesion. Imaging studies, histological evaluation, surgical procedures, and patient management in the two cases are highlighted in the report to provide physicians with additional insight into possible differential diagnoses and treatment options for physicians with similar case presentations.