A 5-year-old child presents since birth with a small midline pit at the dorsum of the nose with occasional clear fluid discharge. There is no visible mass, but the pit extends deep. What is the most important investigation before any surgical intervention?

• A Contrast-enhanced MRI of the nose and anterior cranial fossa ✓
• B Plain X-ray of the skull and nasal bones
• C Fine needle aspiration cytology from the nasal dorsum
• D Biopsy of the pit to confirm the diagnosis

Explanation

A nasal dermoid sinus cyst presents as a midline pit with a potentially deep tract extending through the cribriform plate to the anterior cranial fossa. MRI is essential before any intervention to rule out intracranial extension. Biopsy or probing without imaging risks meningitis or brain injury. The tract may pass through the foramen cecum.

Reference: Scott-Brown's Otolaryngology: Head and Neck Surgery, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.