Hairy polyp of the nasal vestibule

Abstract

© BMJ Publishing Group Limited 2021. No commercial reuse. See rights and permissions. Published by BMJ. DESCRIPTION A male infant was born with a pendulous fleshy mass attached to the right nasal vestibule (figure 1A). The mass caused nasal deviation and interfered with feeding. Bilateral preauricular skin tags, bilateral clefts, a lip pit under the left nostril and dermoid on the limbus of the left eye were also seen on clinical examination. MRI of the head to investigate for intracranial extension revealed bilateral trigeminal nerve hypoplasia, as well as hypoplasia of the right internal auditory meatus with complete atresia of the right facial, cochlear and vestibular nerves. Surgical excision of the nasal mass was performed to alleviate feeding difficulty and for histopathological evaluation. Histology revealed a pedunculated polyp lined by epidermis (figure 1B), with the superficial stroma featuring numerous adnexal structures including hair follicles, sebaceous and eccrine glands and erector pili muscle (figure 1C). The central parts of stroma contained loose cellular fibrous tissue with spindle cells, many variably sized lymphatic spaces and fewer thickwalled blood vessels. Cartilaginous tissue was present near the pedicle (figure 1D). A histological diagnosis of hairy polyp arising from the nasal vestibule was reached. This site of presentation is unusual as most reported cases are within the oropharynx, nasopharynx and middle ear. In view of the other first and second branchial arch anomalies noted on clinical examination and on MRI, the features were considered within the spectrum of Goldenhar syndrome (oculo–auriculo–vertebral spectrum). These findings further support the hypothesis that structures which develop from the first pharyngeal pouch or second branchial arch are possible sites for development of hairy polyps. In conclusion, hairy polyp is a developmental anomaly which can be isolated or occur in association with congenital malformations including first and second arch anomalies, facial hemihypertrophy, cleft palate, etc. Clinical suspicion of a congenital anomaly at this site should prompt imaging studies before management to ensure absence of intracranial extension.