Epidermal inclusion cyst in the nasal vestibule. (Rhinoscopic Clinic).

A white 46-year-old man who had previously undergone nasal polypectomy came to us with a complaint of worsening nasal obstruction. He had no allergic symptoms and did not smoke. On nasal examination, he was found to have bilateral recurrent nasal polyps and a nasal septal deviation. While his nose was being examined, he complained of a growth in the apex of the right nostril. Repositioning the superior blade of the nasal speculum revealed the presence of a nonfluctuant cystic mass in the nasal vestibule. The mass appeared to be pedicled on the lateral nostril without any attachment to the inferior turbinate (figure). The patient said that the lesion was not painful.

Computed tomography (CT) of the sinuses detected the bilateral intranasal polyps and the nasal septal deformity. The anterior cuts of the CT image revealed a round, 11-mm cystic mass that was hypodense to the surrounding tissue and showed a thin rim of higher density (figure).

The patient underwent nasal septoplasty and nasal polypectomy. The cystic mass in the right vestibule was attached by a pedicle to the lateral nostril. This growth was removed via an elliptical incision with primary closure. The mass contained a thick, whitish material. Pathology identified it as an epidermal inclusion cyst.

Cysts in the vestibule are not common. When patients complain of symptoms in the anterior nose or vestibular region, the etiology can include hair follicle inflammation, cysts, nasal polyps, and neoplasms, including papilloma and skin- or mucosa-based malignancies. Careful attention to this region on physical examination and in the anterior CT cuts are important in making the diagnosis. The inclusion cyst in this patient was interesting with respect to its pedicled growth from the skin of the lateral nostril.