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Nasal midline masses of ectodermal origin include nasal dermoids (ND) and nasal dermal sinus cysts (NDSC). NDSC are characterized by an intracranial-extradural extension, while ND are limited to the nasal dorsum, medial canthus, or glabella without intracranial extension. We report our experience in 11 NDSC patients. The goal of this study is to present the management including surgical technique for NDSC and compare it with the literature. Because a transfacial approach for NDSC with vertical incision caused visible scarring in two out of three patients, we applied a new surgical approach in four patients. This approach consisted of a simple excision and mobilisation of the pit while the proximal part is resected using a coronal transfrontal approach. The relation of the nasal fistula to the nasal bone is essential considering osteotomy. Disruption of the bony cartilaginous junction of the nasal dorsum must be prevented to avoid later growth impairment of the nose. There was no recurrence of NDSC in all 7 operated patients after a mean follow-up of 3.9 years (range 0.5-7.2 years).