Surgical approaches to the nasal dermoid cyst

The dermoid cyst usually presents as a mass of the nasal dorsum with or without evidence of a fistulous tract, lined by normal skin, including hair. Approximately 50% of the time the dermoid cyst is deeply located and septal distortion, bone erosion, or intracranial connection may on occasion be discovered. The variations in presentation of these cysts have provoked a variety of recommendations regarding surgical excision. Historical approaches are briefly reviewed. The author favors one of three surgical approaches utilizing incisions that offer good exposure and cosmetically favorable scars. These are outlined in detail. Careful preoperative planning is encouraged, as is the intraoperative use of a lacrimal probe, blunt dissection, and the operating microscope.