iMedPub Journals wwwimedpub.com Case Report DOI: 10.21767/2380-7245.100179 2018 Vol.4 No.3:11 Journal of Rare Disorders: Diagnosis & Therapy ISSN 2380-7245 1 © Under License of Creative Commons Attribution 3.0 License | This article is available from: https://raredisorders.imedpub.com Introducton Usually midline dorsal nasal sinus is a sign of underlying dermoid cyst [1]. They have a unique embryological origin. Other midline nasal masses may be gliomas and encephaloceles which may have an intracranial connecton [2,3]. The common diferental diagnoses of a midline nasal mass may include infammatory lesions, traumatc deformity, benign neoplasms, malignant neoplasms and congenital masses. The purpose of this case report is to discuss about the clinical presentaton, pathogenesis, diagnosis and surgical management of this rare congenital anomaly. Case Report A 23 years, young male patent presented to our out-patent department with history of an opening over dorsum of nose with tuf of hair in it since his childhood. He also complained of on and of white color discharge from that opening but there was no history of nasal obstructon. He had been operated in his childhood for the same complaint but did not get relief of his symptoms. On examinaton, there was a sinus tract of approx 1.5 cm x 0.5 cm size over dorsum of the nose, extending from the supratp region to mid-dorsum. White discharge (foul smelling cheesy material) could be expressed from the sinus opening. Surrounding skin was normal in colour and texture. There was no other apparent congenital anomaly. Anterior rhinoscopy fndings were normal on both the sides. MRI was suggestve of a midline anterior nasal sinus tract with no intranasal and intracranial extension. Mukta Verma* and Arun K Singh Department of Plastc Surgery, King George’s Medical University, Lucknow, Utar Pradesh, India * Corresponding author: Mukta Verma Department of Plastc Surgery, King George’s Medical University, Lucknow, Utar Pradesh, India.  drmukta23@gmail.com Tel: + 9451738117 Citation: Verma M, Singh AK (2018) Approach To Dorsal Nasal Sinus: A Rare Case Report. J Rare Disord Diagn Ther. Vol.4 No.3:11 Management Surgical excision of the sinus tract was planned under local anaesthesia as there was no intracranial extension as suggested by MRI scan. Lidocaine HCl 2% and epinephrine 1: 100,000 injectons were used to provide local anesthesia and vasoconstricton in the operatve feld. Methylene blue dye was injected in the sinus tract and metallic probe was passed in the sinus tract to guide the complete excision of the sinus tract. At frst, an elliptcal incision was given around the sinus tract opening and then it was extended towards the radix. The blind dilated end of sinus tract was reaching upto the nasal bones. It was flled with hair and cheesy foul smelling discharge. Afer complete excision, wound was irrigated with providone iodine soluton and normal saline and closure was done using nylon 5-0. Excised sinus tract was sent for histopathological examinaton and it came out to be a dermoid sinus cyst. Patent was discharged about two hours afer surgical procedure with advice of efectve elevaton of head for about 24 hours to avoid post operatve edema and pain. Post operatve recovery was uneventul and sutures were removed on post operatve day fve. Wound healed with good linear scar. There was no recurrence of symptoms for about 1 year of follow up (Figures 1- 4 ). Approach To Dorsal Nasal Sinus: A Rare Case Report Abstract Congenital midline dorsal nasal sinus is a rare clinical presentaton in our day today clinical practce. Complete surgical excision can cure the patent. We must be careful while taking decision regarding its surgical management as it may have an intracranial extension and neurosurgical consultaton and craniotomy may be required. Here we are discussing our case with the comprehensive approach and review of available literature. Keywords: Dorsal nasal sinus; Midline; Excision; Intracranial; Rare Received: May 14, 2018; Accepted: May 28, 2018; Published: June 04, 2018