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An unusual cause of nasal airway obstruction in a neonate: trans-sellar, trans-sphenoidal cephalocoele

Published online by Cambridge University Press:  27 July 2011

R A Steven ,
M P Rothera ,
V Tang  and
I A Bruce
R A Steven*
Affiliation:
Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK
M P Rothera
Affiliation:
Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK
V Tang
Affiliation:
Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK
I A Bruce
Affiliation:
Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK
*
Address for correspondence: Dr R A Steven, Department of Paediatric OtolaryngologyRoyal Manchester Children's Hospital, Oxford Road, Manchester, United KingdomM13 9WL E-mail: richardsteven@doctors.org.uk
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Abstract

Introduction:

Neonates are obligate nasal breathers, and nasal obstruction may have serious implications. We present an extremely rare cause of neonatal nasal obstruction, and its management.

Case report:

An eight-day-old neonate was referred for upper airway obstruction. Initial investigations had identified no obvious cause. Rigid airway endoscopy revealed a large, cystic lesion appearing to arise from the roof of the posterior nasal space. Computed tomography and magnetic resonance imaging indicated a basal cephalocoele projecting inferiorly into the oropharynx, with an intracranial connection to the pituitary fossa. Histology showed fibrovascular tissue lined on one aspect by respiratory type epithelium, with mucous glands present. The tissue contained multiple cystic spaces lined by choroid plexus epithelium, with glial tissue present in the walls of the mass. A transpalatal excision of the nasopharyngeal cephalocoele, with closure of the intracranial connection, palatal repair and lumbar drain placement was undertaken. Post-operative recovery was uneventful, with no evidence of cerebrospinal fluid leakage or palatal dysfunction.

Conclusion:

This surgical approach gave excellent access whilst avoiding the obvious morbidity associated with an intracranial approach. Nasal masses should be considered in the differential diagnosis of neonatal respiratory distress due to nasal obstruction.

Keywords

EncephaloceleMeningoceleInfant, NewbornAirway ObstructionOtorhinolaryngologic Surgical ProceduresCephaloceleTrans-sphenoidalTrans-sellar
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 125 , Issue 10 , October 2011 , pp. 1075 - 1078
Copyright
Copyright © JLO (1984) Limited 2011

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Footnotes

Presented at the 139th Semon Club, 21 May 2010, Guy's and St Thomas' Hospital, London, winning the Professor Leslie Michaels Award

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