Nasal mass in the newborn

Congenital nasal masses are rare lesions. They can affect the external nose as well as the nasal cavity, the paranasal sinuses, the nasopharynx, the oral cavity and the orbit. Classical midline congenital nasal masses, which are based on a developmental anomaly of the frontonasal region, are dermoid cysts, encephaloceles and gliomas. The following presentation of findings describes such a case. A 3-week-old male neonate presented with an obstructive mass in the left nasal vestibule. In addition to progressive dyspnoea, the parents had noticed the mass for the first time the day before. Drinking behavior was not disturbed. The clinical examination revealed a firm, non-compressible, polyp-like mass of the left nasal vestibule with absent misting on a metallic oral spatula. In addition, inter- and subcostal retractions, intermittent wheezing, and tachypnea were noted. For further classification of findings, an MRI of the paranasal sinuses was performed, which showed a mass measuring 1.5 x 0.6 x 1.4 cm in the left nasal cavity with a shift of the nasal septum to the right. The mass was excised under intubation anaesthesia and sent for pathohistological examination. The pathohistological report revealed GFAP and S100 positive, inflammatory overlapping glial tissue in the subepithelial tissue which corresponded to glial heterotopia. In accordance with the motto of the congress, this case underlines the necessity of interdisciplinary cooperation between ENT, paediatrics, radiology and pathology. Due to the elevated laryngeal position, newborns are obligate nasal breathers in the first 4-6 weeks of life, so that a unilateral nasal mass can lead to clinically relevant dyspnea, which must be treated as quickly and as effectively as possible.