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Nasal glioma: A case report.

Abstract

Nasal gliomas are rare, benign, congenital tumors that are thought to be the result of an abnormality in embryonic development. Three types of clinical presentations have been recognized. extranasal (60%), intranasal (30%), and combined (10%). Clinically, these masses are firm, noncompressible, nonpulsatile, gray or purple lesions that obstruct the nasal cavity intranasally and cause deformity extranasally. Histologically, these tumors are made up of astrocytic neuroglial cells interlaced with fibrous and vascular connective tissue that is covered with skin or nasal respiratory mucosa. The preferred treatment is excision via a frontal craniotomy approach for those patients whose gliomas have an intracranial connection, for those patients who have cerebrospinal fluid rhinorrhea, and for those who have recurrent episodes of meningitis. Otherwise, a transfacial lateral rhinotomy is advised. In this article, we describe a case of a nasal glioma that was removed via a lateral rhinotomy.

Introduction

Nasal gliomas are rare tumors of neurogenic origin. Embryologically, they are considered to be similar in etiology to an encephalocele without intracranial linkage. The incidence of congenital nasal masses has been reported torange from 1 in 20,000 to 1 in 4O,O00 live births. [1] These congenital malformations are classified as nasal encephaloceles, dermoids, and nasal gliomas. In this article, we describe the case of a nasal glioma that was removed via a lateral rhinotomy. We also discuss the pathogenesis, clinical manifestations, and treatment of these tumors.

Case report

We examined a 2-year-old aboriginal girl who had been born following a normal pregnancy and during a normal delivery. When she was 6 months old, she began to experience noisy respiration and mouth breathing, and she exhibited a right nasal mass that had enlarged slowly. She manifested no evidence of trauma or other congenital deformity.

On examination, we observed a soft, gray, elastic mass occupying her right nasal cavity (figure 1). We also noted a lateral displacement of the nasal septum and a widening of the nasal root. Computed tomography (CT) detected a well-defined intranasal soft tissue mass without evidence of any intracranial extension or bone defect of the skull base (figure 2). The tumor was attached via a fibrous pedicle to the lateral nasal wall. It was removed via lateral rhinotomy without cerebrospinal fluid rhinorrhea. The mass measured 4.0 x 1.2 x 1.0 cm (figure 3). Following excision of the tumor, the nasal cavity was packed with ampicillin-soaked gauze strips, which were removed on the fourth day postoperatively.

Histologically, the tumor consisted of astrocytic neuroglial cells that were surrounded by fibrous connective tissue and covered with normal nasal mucosa (figure 4). The definitive diagnosis was a nasal glioma. The patient has been followed for 4 years without recurrence or the appearance of any facial deformity.

Discussion

Most nasal gliomas are diagnosed at birth or during early childhood. [2-4] Nasal gliomas arising in adults are extremely rare. There is no recognized familial tendency, malignant potential, sex predilection, or association with developmental anomalies. [4]

These tumors can occur outside the nasal cavity (60% of cases), within the nasal cavity (30%), and in both sites (10%). [4, 5] Our patient had the intranasal type. Clinical presentations feature a firm, noncompressible mass that does not expand during crying or during Valsalva's maneuver (negative Furstenburg's test), unlike nasal encephalocele. [2-5] Overall, only 10 to 15% of gliomas have a connection to the dura.

The diagnosis of nasal glioma is facilitated by CT or magnetic resonance imaging, but a definitive diagnosis is often obtained only after a complete resection. Biopsy and needle aspiration should be avoided because they increase the risk of meningitis. [5,6]

Histologically, nasal gliomas are characterized by unencapsulated collections of astrocytic eosinophilic neuroglial cells in a connective tissue matrix. [3,4]

The treatment of choice is a complete surgical extirpation to avoid recurrence. [3] The most appropriate surgical method--via either an intranasal or external approach--is controversial. [6] The intranasal approach to endoscopic removal offers an advantage aesthetically, but it carries the risk of an incomplete resection. The external rhinoplastic approach, which can be performed as a lateral rhinotomy or frontal craniotomy, carries the risk of causing a facial deformity.

From the Department of Otolaryngology, Mackay Memorial Hospital, Taipei, Taiwan.

References

(1.) Hughes GB, Sharpino G, Hunt W, Tucker HM. Management of the congenital midline nasal mass: A review. Head Neck Surg 1980;2:222-33.

(2.) Swift AC, Singh SD. The presentation and management of the nasal glioma. Int J Pediatr Otorhinolaryngol 1985;10:253-61.

(3.) Gorenstein A, Kern EB, Facer GW, Laws ER. Nasal gliomas. Arch Otolaryngol 1980;106:536-40.

(4.) Ducic Y. Nasal gliomas. J Otolaryngol 1999;28:285-7.

(5.) Claros P, Bandos R, Claros A, et al. Nasal gliomas: Main features, management and report of five cases. Int J Pediatr Otorhinolaryngol 1998;46:15-20.

(6.) Pasquini E, Farneti G, Giausa G, Biavati M. A rare case of nasal glioma in adult age. Otolaryngol Head Neck Surg 1998;118:905-6.
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Article Details
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Author:Leu, Yi-Shing
Publication:Ear, Nose and Throat Journal
Geographic Code:1USA
Date:Jun 1, 2001
Words:818
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