Hole on the back
A small pit or opening along the middle line of the nose.
CONDITION / CARRY
Fistula of the back of the nose.
Fistula of the back of the nose is a congenital channel or cyst on the back of the child's nose, most often dermoid. It does not disappear by itself and can become inflamed, so it is removed surgically - completely, after MRI or CT.
CONCEPTUAL VISUALIZATION- what is it
- Congenital canal or cyst along the midline of the nose, lined with skin.
- When noticed
- Usually in early childhood: in a series of 129 children, the average age at first appointment was 12 months.
- What is dangerous?
- It becomes inflamed, and sometimes extends deep into the cavity of the skull.
- How to treat
- Complete surgical removal after MRI or CT scan.
01 / WHAT IS ITWhat is
What is
nasal fistula.
During fetal development, facial tissues grow along the midline. If an island of skin remains in this place, a dermoid cyst or channel — a fistula — is formed, which opens through an opening on the back of the nose.
There is a cyst under the skin, a fistula with an opening, or a combination of both. Most of these formations are superficial, but some extend deep into the nose or into the skull cavity.
Nasal dermoids account for only 3.7–12.6% of head and neck dermoid cysts, so they are uncommon. But due to the possible connection with the cavity of the skull, they are carefully examined and operated on.
This is general information. Tactics for your child will be determined by the doctor after examination and examination.
02 / SIGNSHow it
How it
manifests itself.
The defect is noticeable from birth or in the first years of life, although sometimes only when it becomes inflamed.
Hair
A hair may grow from the opening — a characteristic sign.
Allocation
Cheesy contents are periodically released from the hole.
Swelling
A dense painless formation under the skin of the back or near the bridge of the nose.
Inflammation
Redness, swelling, pain - the fistula has become infected. In a series of 29 children, 31% had inflammation.
03 / REASONSWhy it
Why it
occurs.
It is a developmental disability, not the result of illness, injury or care.
Development of the face
The main theory is a violation of the fusion of tissues along the middle line and capture of the island of skin in depth.
The depth
Formations are divided into superficial, with a channel and with spread into the skull cavity.
Rarity
Dermoids of the head and face account for approximately 7% of all dermoids and occur in 0.03–0.14% of people.
Spread to the skull
The frequency is different in the series: in 129 children, such spread during the operation was found in 8.5%.
04 / SEEK MEDICAL ADVICE
When to seek urgent medical care?
Nasal fistula usually does not require emergency care. But if it extends to the skull cavity, the infection can spread inside.
103 immediately if:
- high temperature with severe headache, vomiting, neck stiffness or sleepiness of the child.
To the doctor on the same day, if:
The area of the fistula is red, swollen, painful, and pus has appeared. If you notice a hole or swelling on the back of the nose, make an appointment for a scheduled consultation. Don't squeeze out the contents or agree to a biopsy until an MRI or CT scan is done.
05 / DIAGNOSTICSHow a
How a
child is examined.
- Review
The doctor evaluates the opening, swelling and signs of inflammation.
- MRI
The main method: shows whether the formation extends to the cranial cavity.
- CT scan if necessary
Assesses the bones of the nose and skull.
- No biopsy before pictures
Formations on the nose are examined with pictures even before any biopsy - because of the risk of communication with the skull cavity.
06 / TREATMENTHow to treat
How to treat
nasal fistula.
The method of choice is complete surgical removal. The risk of return depends on how completely the canal and cyst are removed.
01
Operation
Access depends on the type and depth of the formation.
- External cut
- In a meta-analysis of 439 cases, the external incision gave the least recurrences (1.78%) and complications (4.94%).
- Through rhinoplasty access
- Relapses — 4.81%, complications — 8.32%; the scar is less noticeable.
- Endoscopically
- The least traumatic, but in the summary of data — the highest recurrence rate (7.89%); fits selectively.
02
If the formation extends into the skull
- Joint operation
- Sometimes a neurosurgeon is needed. Operations through an incision on the nose with endoscopic support without trepanation are also described: in a series of 18 patients, 15 managed without trepanation, there were no recurrences in any of them; Whether this approach is appropriate depends on the size of the cyst.
03
After surgery
- Observation
- Follow-up examinations are necessary to detect a relapse in time. In a series of 29 children aged 1–8 years, recurrence was found in one case, and the appearance after surgery was satisfactory.
07 / AT THE VALIKHNOVSKY CLINIC
How do we
How do we
treat it.
Fistula of the dorsum of the nose at Dr. Valikhnovsky's Institute of Surgery is removed in the "New Nose" direction - after MRI or CT, taking into account how to change the shape of the nose the least.
DIRECTION TO THE CLINIC
A new nose
Shape, support and breathing of the nose: septum, concha, sinuses, consequences of injuries, failed operations and removal of tumors.
Go to direction
What do we do in this condition
- Excision of a congenital fistula of the dorsum of the nose — complete removal of the canal and cyst.
- Cartilage grafts — if after removal it is necessary to restore the support of the back.
Rostislav Valikhnovsky
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovsky Institute of Surgery.
How is the treatment in us
- Photo onlineSend a photo of the child's nose - the doctor will first assess the formation.
- ConsultationSurvey and survey plan.
- MRI or CTTo know how deep the fistula extends.
- OperationComplete removal of the canal and cyst; if the images showed spread into the cranial cavity, tactics are discussed separately.
- ControlExaminations after surgery to avoid recurrence.
08 / QUESTIONS AND ANSWERSFrequently asked
Frequently asked
questions.
Short answers. What is right for you, the doctor will tell you during the consultation.
Can a fistula on the nose disappear by itself?
No. The congenital duct or cyst remains and may become inflamed. Treatment is complete surgical removal.
At what age is the operation performed?
Usually in early childhood, after examination: in a series of 25 children, the average age at surgery is 3.7 years. The doctor determines the terms.
Why MRI before surgery?
To see if the fistula extends into the cranial cavity. Access and composition of the operational team depend on this.
Will there be a scar?
Depends on access. An external incision on the nose gives the least relapses, rhinoplasty approach - a less noticeable scar. The choice is discussed with the parents.
Can the fistula come back?
Yes, if part of the channel remains. According to a meta-analysis of 439 cases, after removal through an external incision, recurrences were 1.78%.
What is more accurate: CT or MRI?
Studies differ: in one, CT more accurately predicted spread to the skull, in another, MRI. For children under 5 years of age, some authors advise combining both methods. The doctor decides what your child needs.
What to do if the fistula is inflamed?
See a doctor the same day. Do not squeeze content. The operation is usually planned after the inflammation subsides.
Sources
10 sources · reviews, guidelines and studiesShowCollapse
- Operative options for extracranial nasal dermoid cysts: A meta-analysisJournal of Plastic, Reconstructive & Aesthetic Surgery, 2024doi:10.1016/j.bjps.2023.10.114 ↗
- Paediatric nasal dermoid: evaluation and managementCurrent Opinion in Otolaryngology & Head and Neck Surgery, 2021doi:10.1097/MOO.0000000000000765 ↗
- Pediatric nasal dermoid sinus cysts: advances in pathogenesis, management strategies, and translational research — a multidisciplinary management perspectiveFrontiers in Pediatrics, 2025doi:10.3389/fped.2025.1708853 ↗
- Preoperative Imaging and Surgical Findings in Pediatric Frontonasal DermoidsLaryngoscope, 2024doi:10.1002/lary.31079 ↗
- Risk of Intracranial Extension of Craniofacial Dermoid CystsPlastic and Reconstructive Surgery, 2020doi:10.1097/PRS.0000000000006655 ↗
- Midline nasofrontal dermoids in children: A review of 29 cases managed at Mansoura University HospitalsInternational Journal of Pediatric Otorhinolaryngology, 2016doi:10.1016/j.ijporl.2016.01.005 ↗
- Pediatric nasal dermoid — a decade’s experience from a South Indian tertiary care centreInternational Journal of Pediatric Otorhinolaryngology, 2020doi:10.1016/j.ijporl.2020.110418 ↗
- Radiological diagnostics in nasal dermoids: Pitfalls, predictive values and literature analysisInternational Journal of Pediatric Otorhinolaryngology, 2021doi:10.1016/j.ijporl.2021.110842 ↗
- Transnasal Endoscopic Approach for Excision of Intracranial Nasal Dermoid Sinus CystsJournal of Craniofacial Surgery, 2025doi:10.1097/SCS.0000000000010582 ↗
- Pediatric teratoma and dermoid cystsOtolaryngologic Clinics of North America, 2015doi:10.1016/j.otc.2014.09.009 ↗
The figures on the page are from these sources.
A hole or a lump
on the child's nose?
Send a photo and describe when you noticed it. The doctor will tell you what tests are needed and when to operate.