A Case of Primary Septal Cyst Removed by Transnasal Endoscopic Surgery

Abstract

Nasal septal cyst often occurs as a complication after septoplasty or rhinoplasty, and has also been reported as a phenotype of pleomorphic adenoma, dermoid cyst, tuberculosis, or aneurysmal bone cyst in the final pathological diagnosis. Among these, a primary simple cyst of the nasal septum is extremely rare. Although no treatment strategy has been established for a nasal septal cyst, several surgical methods, such as cyst fenestration, open septorhinoplasty, or and total excision have been reported. Total excision is recommended in cases with no history of septal surgery to prevent recurrence of the lesion; however, careful handling is necessary to avoid damage to the L-strut and keystone area during the surgery, to prevent postoperative nasal deformity.

We present the case of a 71-year-old woman with a septal cyst who was referred to our hospital with a 3-month history of bilateral nasal congestion and nose pain. Physical examination revealed a septal mass that protruded into both sides of the nasal cavity. Based on the findings of computed tomography and magnetic resonance imaging, the patient was diagnosed as having a primary simple cyst of the nasal septum. We performed complete excision of the cyst from the nasal mucosa and of the deformed nasal septal cartilage via transnasal endoscopy. The postoperative course was uneventful. No complications, such as saddle-nose deformity and nasal septal perforation were encountered, and the subjective symptoms were alleviated.

In this case, we were able to perform total cystectomy without complications by applying the septoplasty approach. By mastering basic surgery, it will be possible to safely approach rare cases such as this one.