DOI No.: 10.21176/ ojolhns.0974-5262.2015.09.

NASAL GLIOMA IN 18 MONTH CHILD

*D Kumar, **A Agrawal, ***N Shree, ****C Gupta, *****AP Verma

ABSTRACT

INTRODUCTION

Nasal gliomas are uncommon congenital benign

Nasal glioma is rare, benign, congenital mass

lesions arising from abnormal embryonic development.

more accurately referred to as sequestered glial

Clinically, these masses are firm and noncompressible.

tissue . The nasal glioma first described by Schmidt

Proper management of a nasal glioma requires a

multidisciplinary
otorhinolaryngologist,

approach
radiologist,

including
and

an

neurosurgeon.

Radiological investigations such as computed tomography

or magnetic resonance imaging should be performed to

2,3

in 1900

. Sixty percent of glioma are extranasal,

4

30% are intranasal, and 10% are both . Extranasal

gliomas appear near the root of the nose. The
5

overlying skin may be discolored or telangiectatic .

exclude intracranial extension. The mainstay of treatment

We described a nasal glioma, located extranasally.

is conservative surgical excision because nasal gliomas

CASE REPORT

are slow-growing, rarely recurrent, and have no malignant

An 18 month old female child presented to E.N.T.

in 18 months female. She underwent surgical excision

outpatient department of Sarojini Naidu Medical College,

with good cosmetic results. Postoperative period result

Agra, India with chief complaint of swelling left side of

was uneventful.

nose since birth, which had gradually increased in size

Key words: nasal glioma, extranasal,

benign.
Address of Correspondence:
Dr. Dharmendra Kumar
Prof. & H.O.D., Dept. of ENT
Sarojini Naidu, Medical College
Agra-282002, Uttar Pradesh, India
Phone - +919412157647
E-mail: Dharmendra.snmc@yahoo.co.in

since birth. She had not suffered pain or nose bleeds.

There was no history of nasal obstruction or epistaxis.
She was a full-term child. There was no other relevant
history.

Physical

evaluation

revealed

that

the

subcutaneous swelling was 2x1 cm in size, at the root of

nose just slightly left of the midline. It was not tender, nonmobile, and non-pulsatile, overlying skin is normal.
Anterior rhinoscopy was normal and there was no mass
inside the nose. The mass did not increase in size when
the child cried and on coughing. Other systemic
examinations were unremarkable. Her CT scan was done
and it showed smooth outline soft tissue density nodular
lesion seen over left side of nose,

*Professor and Head ENT, **Assistant Professor Dept. of ENT, Department of Microbiology, ***Resident ENT ****Assistant professor, Post
Graduate Department of Pathology, *****Resident, Department of ENT, Sarojini Naidu Medical College, Agra, India

37

Vol.-9, Issue-I, Jan-June - 2015

potential. We report one case of extranasal nasal glioma

DOI No.: 10.21176/ ojolhns.0974-5262.2015.09.1

measuring 1.5x1.6x2.0 cms in size smooth scalloping is

seen in antero-inferior aspect of underlying left nasal
bone. No significant contrast enhancement is seen within
the lesion. Intranasal extension of lesion is seen with
thickening of anterior aspect of nasal septum. Subtle
thickening in antero-superior aspect of nasal septum
seems to extend into the right side of cribriform plate with
small bony gap (likely thin connecting pedicle), likely
suggestive of nasal glioma. The mass was excised with a
lateral rhinotomy incision under general anesthesia. The
Histopathology

showed

features

of

glioma

Postoperatively recovery was uneventful.

Fig.1: Swelling at nose

DISCUSSION
Nasal gliomas are not true neoplasms; they
originate from ectopic glial tissue left extracranially
following abnormal closure of the nasal and frontal
bone during embryonic period.
Therefore, some authors recommend using the
8

glialterm instead . They are locally aggressive lesions

noticed at birth or during early childhood, but may be
present at any age

4,5

. The skin covering them may have

Fig. 2 : Excised swelling

telengiectasia. Nasal gliomas are seen more often in

5

females, with a female:male ratio of 3:1 . Our patient is an

18-month old female. Extranasal gliomas are skin-covered
nodules most often located at the bridge or root of the
nose, although they may also be found at the nasal tip.

Vol.-9, Issue-I, Jan-June - 2015

They are often located slightly to one side of the midline

10

and range in size from 1 to 5 cm . In our patients, tumor

was located at the root of the nose, just slightly to one
side of the midline, and it was nodular in appearance.
Nasal encephaloceles and nasal gliomas have a similar
embryological origin but, as the nasal encephalocele is a
herniation of the intracranial contents, it must have an
intracranial connection through a bone defect. The nasal
glioma, however, is ectopic

38

Fig. 3: Areas of glial differentiation H&E X100

DOI No.: 10.21176/ ojolhns.0974-5262.2015.09.1

sequestrated tissue and not a herniated structure,

REFERENCES

although a connection with CNS is present in 15-20% of

1.

Thomson HG, al-Qattan MM, Becker LE. Nasal

cases. It is considered important to distinguish nasal

glioma: is dermis involvement significant? Ann

glioma as from nasal encephaloceles because of the risk

Plast Surg 34: 168-72, 1995.

of infection spreading inward along the intracranial

2.

Dini M, Lo Russo G, Colafranceschi M. So-called

communication in the latter to produce meningitis .

nasal glioma: case report with immuno-

Diagnosis of both intranasal and extranasal gliomas

histochemical study. Tumori 84: 398-402, 1998.

involves a detailed CT study of the nasofrontal area and

3.

Yeoh GP, Bale PM, de Silva M. Nasal Cerebral

anterior cranial fossa to rule out intracranial connections.

Heterotopia: The so-called nasal glioma or

Needle aspiration of these masses is to be avoided,

sequestered encephalocele and its variants. Pediatr

because of the danger of iatrogenic meningitis. Other

Pathol 9: 531-49, 1989.

intranasal neural tumors, including neurofibromas, and

4.

neurilemmomas may be distinguishable from intranasal

Brown K, Brown OE. Congenital malformations

of the nose. In: Cummings CW, Fredrickson JM,

gliomas. Extranasal gliomas with no obvious CNS

Harker LA, Krause CJ, Schuller DE, Richardson

connection may be excised externally. Postsurgical

MA (eds). Otolaryngology Head and Neck

defects of the nasal bones may spontaneously fill in over

Surgery, 3rd edition, Mosby Year Book, St. Louis,

11

time or may require bone grafting at a later date . If a

CSF leak is encountered, a bifrontal craniotomy approach

1998, pp: 92-103.

5.

may be required.

Hengerer AS, Newburg JA . Congenital

malformations of the nose and paranasal sinuses.
In: Bluestone CD, Stool SE, Scheetz MD (eds).

Intranasal gliomas usually arise from the lateral

nasal wall and can be approached via a lateral

Pediatric Otolaryngology. W.B. Saunders

rhinotomy incision or endoscopic approach. For pure

Company, Philadelphia, 2nd edition, 1990, pp:

718-28.
6.

Haafiz AB, Sharma R, Faillace WJ. Congenital

mass with no postoperative facial deformity . If an

midline nasofrontal mass. Two case reports with

intracranial connection is found, a craniotomy or an

a clinical review . Clin Pediatr (Phila)

external ethmoidectomy may be necessary . Lateral

rhinotomy incision was done in our patient. During the

1995;34:482-6.
7.

Paller AS, Pensler JM, Tomita T. Nasal midline

10-month follow-up period no recurrences was seen.

masses in infants and children. Dermoids,

DISCLOSURES

encephaloceles, and gliomas. Arch Dermatol

1991;127:362-6.

(a) Competing interests/Interests of Conflict- None

(b) Sponsorships - None

8.

(c) Funding - None

Rahbar R, Resto VA, Robson CD, et al. Nasal

glioma and encephalocele: diagnosis and

9.

2015

is recommended for complete removal of the intranasal

V
o
l.
9
, Issue-I, Jan-June -

intranasal gliomas, a transnasal endoscopic approach

Verney Y, Zanolla G, Teixeira R, Oliveira LC.

Midline nasal mass in infancy: a nasal glioma case

report. Eur J Pediatr Surg 2001;11: 324-7.

11. S

10.

Oddone M, Granata C, Dalmonte P, Biscaldi E,

paranasal sinuses, and nasopharynx. In: Bluestone

Rossi U, Toma P. Nasal glioma in an infant.

CD, Stool SE, Scheetz MD (eds). Pediatric

Pediatr Radiol 2002;32:104-5...Kennard CD,

Otolaryngology. W.B. Saunders Company,

Rasmussen JE. Congenital midline nasal masses:

Philadelphia, 2nd edition, 1990, pp: 780-92.

management. Laryngoscope 2003;113: 2069-77

39.