Management of nasal fistulas with intracranial extension

Background: Medial nasal fistulas are rare congenital malformations that mostly become obvious by recurrent infections such as secretion from the fistula opening or swelling of the nasal tissues. In rare cases, these fistulas may extend intracranially with meningeal irritations. Patient Presentation: Three patients with medial nasal fistulas were operated during the last two years in our department. In two children, the fistulas ended at the glabella. In one older boy, the fistula revealed an intracranial extension. In the last case, a combined rhino- and neurosurgical approach was applied to perform a complete resection of the fistula. Discussion: During the second embryonic month of facial development, the medial nasal processes approach each other with a fusion of their epithelial covering that completely disappears during later stages. If parts of this epithelial fusion zone persist, epithelial remnants may develop into nasal fistulas or dermoids. The adequate therapy of these nasal malformations consists of a complete surgical removal.