Nasal Obstruction
Michelle A. Michel, MD
DIFFERENTIAL DIAGNOSIS
Common
Nasolacrimal Duct Cyst
Nasal Choanal Atresia
Less Common
Nasal Dermal Sinus
Frontoethmoidal Cephalocele
Nasal Glioma
Sinonasal Hemangioma
Prominent/Asymmetric Tonsillar Tissue
Rare but Important
Pyriform Aperture Stenosis
Rhabdomyosarcoma
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
Bilateral nasal cavity lesions in newborn produce respiratory distress as newborns are obligate nasal breathers
Unilateral lesions that do not cause respiratory distress may present later in childhood
Helpful Clues for Common Diagnoses
Nasolacrimal Duct Cyst
Inferior meatus location produces nasal obstruction
Well-defined cystic lesion below inferior turbinate; dilated nasolacrimal duct
Nasal Choanal Atresia
Stenosis > atresia; unilateral:bilateral (2:1); bony (90%) and membranous (10%)
CT: Posterior nasal cavity narrowed by thickened vomer and medialized maxilla; soft tissue or bony plate occludes choanae
Helpful Clues for Less Common Diagnoses
Nasal Dermal Sinus
Fluid-filled cyst or sinus tract from foramen cecum to nasal tip; within midline septum; bifid crista galli
Frontoethmoidal Cephalocele
Nasoethmoidal form presents as intranasal mass; may enlarge with crying; intracranial connection
Nasal Glioma
Well-defined soft tissue mass with no connection intracranially
MR: Signal typically not similar to brain and may enhance
Sinonasal Hemangioma
Enhancing lesion along anterior nasal septum; T2 hyperintense
Prominent/Asymmetric Tonsillar Tissue
Midline nasopharyngeal soft tissue
Helpful Clues for Rare Diagnoses
Pyriform Aperture Stenosis
Bony narrowing of anterior nasal passageway
Associated maxillary central megaincisor and midline intracranial anomalies
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