Atypical congenital dermoids of the face: a 25-year experience.

OBJECTIVE: To review the presentation and management of nasal and other facial dermoid cysts and sinuses (excluding external angular dermoids). We report on 28 patients with less common facial dermoids. They presented as a cyst, sinus or both and may be separated into four groups. Group 1 (18 cases) were in the midline on the nose and many (12) had extensions to the septum but only two to the skull base. Group 2 (two cases) were paramedian nasal lesions and one extended through the nasal bones. Group 3 were lesions around the medial orbital wall, and two of these had tracts extending into the orbit. Group 4 were a miscellaneous group of lesions on the cheek and lips. We observed that preoperative imaging, although useful and done mainly for medico-legal reasons, may not detect deep extensions and therefore surgeons should be prepared for a more involved procedure when removing atypical facial dermoids.