Craniosynostosis and Cranial Reconstruction Center

Patient Stories | Peyton and Nasal Dermoid Cyst

Alabama Mom Scours the Internet to Find a Different Type of Surgery for Her Son’s Nasal Dermoid Cyst

Sara Allen noticed the tiny indentation on her son’s nose the day he was born in 2018. Three years later, “Don’t worry, it’s not a problem” became “You need to see a specialist.” 

“I found out what the indentation was in 2021 only because I took Peyton to an ear, nose and throat specialist for chronic ear infections,” said Sara, who lives with her family in Alabama. “The doctor knew just by looking at it that Peyton had a nasal dermoid cyst.”

A nasal dermoid cyst is rare. It forms in the skull base during prenatal development, grows into a barbell shape and runs along the nasal bone and cartilage. While not cancerous, nasal dermoid cysts don’t just go away. If left untreated, they can cause serious complications.

Imaging scans suggested that the cyst in Peyton’s nose might be growing into his brain. Doctors recommended that Sara and her husband, Matt, take Peyton to a neurosurgeon. The closest one was five hours from their home, so the Allens packed up their family and made the drive.

This is where the story goes from scary to terrifying, Sara said. “The neurosurgeon told us that to remove the cyst, he’d have to make an ear-to-ear incision, peel the upper part of Peyton’s face down to the nose level, and cut away bone to access the nasal cavity. He said the swelling would be so bad we might not even recognize Peyton afterward and that Peyton would be in the hospital for three days.”

At the end of the conversation, Sara remembers the neurosurgeon telling her open surgery was the only way he knew how to remove the cyst—and if she could find someone to do it differently, she should. 

Back on the Road

So that’s exactly what Sara did. In addition to learning everything she could online about nasal dermoid cysts, she found a small and supportive Facebook group for parents of children with the condition. One of the moms told her about her son’s surgery at Cincinnati Children’s, mentioning two of our doctors by name—pediatric neurosurgeon Jesse Skoch, MD, and pediatric plastic surgeon Brian Pan, MD. 

Dr. Skoch and Dr. Pan are among the few pediatric surgeons in the country to offer minimally invasive alternatives to “open” nasal dermoid cyst surgery. Their approach results in a small incision, very little swelling, minimal scarring, an overnight hospital stay and a brief recovery period at home.

Sara immediately reached out to Cincinnati Children’s and found experts within the Craniosynostosis and Cranial Reconstruction Center and the Pituitary and Skull Base Surgery Center. A few months later, the Allen family was on the road again, this time north to Cincinnati. 

“When Dr. Skoch and Dr. Pan came into the exam room, they told us they’d discussed Peyton’s imaging scans and didn’t think the cyst was growing into his brain after all,” Sara recalled. “But even if it was, they believed they could operate through the nose using minimally invasive techniques. I was shocked and confused but mostly just completely thrilled. It was the first good news we’d received in months.” 

A One-Inch Incision

Dr. Skoch explained that open surgery to remove a nasal dermoid cyst is the standard of care and is considered safe and effective. He added that he and Dr. Pan could “convert” to an open approach during surgery if needed. But since developing their minimally invasive methods, they haven’t had to.

Back in 2017, Dr. Skoch came up with the idea of removing nasal dermoid cysts using minimally invasive techniques. It’s similar to what he had already been using to remove tumors located in the skull base. 

“It was a little nerve-wracking to consider doing this surgery differently than anyone else in the country,” Dr. Skoch said. “Dr. Pan and I talked at length about whether it was feasible and safe before doing our first minimally invasive cyst removal together. We’ve gained a lot of confidence in the approach over the years and see the potential for it to one day become the standard of care.”

The Allens didn’t need any convincing. Two months later, they returned to Cincinnati Children’s for Peyton’s surgery. Advanced imaging confirmed that the cyst hadn’t grown into Peyton’s brain. Dr. Skoch removed it through a one-inch incision, and Dr. Pan closed the incision with techniques to reduce the potential for scarring. Peyton was discharged from the hospital a few hours later—cheerful and eating a popsicle and just a little bit swollen around his nose. Today, he’s a perfectly healthy, “wild and energetic” 5 year old who loves Power Rangers and playing baseball.

Pushing the Boundaries

“We are so grateful to Cincinnati Children’s,” Sara said. “The surgeons were incredible. They take the time to answer your questions, and it’s so obvious they care. Everyone we met at the hospital—from the security guards and food service staff to the nurses and surgeons—was just wonderful.”

Patient experiences like these motivate doctors at Cincinnati Children’s to keep pushing the boundaries of what’s possible, Dr. Pan explained.

“Cincinnati Children’s is a place where we don’t limit ourselves to doing what’s always been done,” he said. “Doctors from different areas of expertise collaborate to develop new ideas and approaches. It’s exciting to learn from each other as we provide the best possible outcome for children and their families.”  

(Published July 2023)