PMC6379832_01
Frontal (a) and profile (b) images of the patient. Facial image of the face (a) showing the mass and the fistula's orifice indicated by the arrow and of the profile of the face (b) showing the frontal mass in the shape of a small arch facing the glabella
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F1
Clinical examination showed a nasofrontal fistula allowing a flow to the top of a small inflammatory mass slightly sensitive to palpation (Figure 1 (Fig. 1)) evolving in a context of apyrexia and conservation of the general state.
Frontal radiograph of the skull (a) showing nasofrontal bone defect and axial brain MRI weighted sequences T1 (b), T2 (c), and T1 contrast enhanced (d). The lesion sits in the medial basifrontal and appears hypointense on T1 and hyperintense on T2 sequences, and enhances after injection of the contrast product (d).
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F2
The frontal standard radiography of the skull showed a medial frontal bone defect (Figure 2a (Fig. 2)). Magnetic resonance imaging (MRI) of the brain (Figure 2b-d (Fig. 2)) demonstrated a median basifrontal cystic lesion in favor of a fistula associated with a nasofrontal cyst, which appears hypointense on T1 (Figure 2b (Fig. 2)) and hyperintense on T2 (Figure 2c (Fig. 2)) and enhances after gadolinium injection (Figure 2d (Fig. 2)), underlining that the infectious assessment was normal.
Preoperative image (a) showing the marking of the incision, intraoperative image (b) made during the excision of the cyst, and image of the cyst after complete excision (c)
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F3
The patient was operated by performing a small, median nasofrontal incision centered on the mass (Figure 3a (Fig. 3)), careful dissection around the cyst (Figure 3b (Fig. 3)), and its complete removal (Figure 3c (Fig. 3)).
Intraoperative image showing the defect of the bone and the dura after removal of the cyst (a). The clogging of the bone defect by the external table of the frontal bone (b), then an intraoperative view when taking a small flap of the external table of the frontal bone (c).
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F4
The defect of the dura mater (Figure 4a (Fig. 4)) was closed by making hermetic sutures, and the bone defect was clogged by a small flap of the external table taken from the frontal bone in precoronal (Figure 4a-b (Fig. 4)). The incision was esthetically closed by continuous absorbable intradermal sutures. The postoperative follow-up was simple without any incidents with excellent healing of the wound.
Image showing the esthetic result obtained at . 10 months after surgery
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F5
Histological examination confirmed the diagnosis of the dermoid cyst and we report a very satisfying aesthetic result obtained 10 months after the surgical intervention (Figure 5 (Fig. 5)).