Dermoid Polyp – a rare differential diagnosis of infantile airway obstruction

Introduction Dermoid polyps are rare, congenital space-occupying lesions that arise from scattered ectodermal and mesodermal cells as embryonic tissue heterotopia. Thus, they usually consist of a surface covered with keratinizing squamous epithelium and a core in which adipose tissue, muscle cells, and cartilage may be present. According to the extremely few case reports available, they occur with a ratio of 1:3-1:6 in girls and are predominantly localized in the naso- and oropharyngeal space. Typically, pharyngeal dermoid polyps become conspicuous by obstructive airway symptoms.

Case In 2020, a 4-year-old girl presented to us with an mass of the nasopharynx. Anamnestically, there were rhonchopathies and occasional tympanic effusions; beyond that, the child was symptom-free. Inspection revealed a pedunculated mass of the nasopharynx, most likely originating from the nasal velum and covered with keratinizing squamous epithelium. MR morphologically, the mass was described as a 16x7mm cystic structure without contact to the skull base. With the middle ear now ventilated and the patient symptom-free, we checked the structure endoscopically; it remained constant over the course of 2 years. For further clarification in the now 6-year-old girl, the parents requested surgical ablation of the mass. Intraoperatively, we found an epithelialized, solid structure starting from the anterior tubal bulge on the left side, which we ablated via monopolar electrocaustics. Histopathologically, a dermoid polyp measuring 1.5x1x0.9 cm could be detected.

Conclusion Dermoid polyps should be considered as a rare differential diagnosis in the workup of infantile upper airway obstruction.

Publication History

Article published online:
12 May 2023