Postrhinoplasty nasal cysts and the use of petroleum-based ointments and nasal packing

Excision and reconstruction of dorsal nasal mucous cyst using dorsal nasal flap technique: a case report and literature review

Congenital nasal masses are very rare presentations. Among these masses is a mucous cyst, which might be considered either a congenital or an acquired mass. Our report presents a case of recurrent dorsal nasal swelling that was initially managed with an open rhinoplasty. However, 1 year after the surgery, the swelling started to grow rapidly, and the patient presented with a disfigured nose. We scheduled the patient for the excision of the dorsal nasal swelling and reconstruction using the dorsal nasal flap approach. Several surgical techniques have been performed and published in the literature; however, this is the first time the dorsal nasal flap technique is being reported as a surgical approach to dorsal nasal mucous cysts. While mucous cyst formation might be congenital, the majority occur after rhinoplasty surgery. However, they can be prevented by minimizing unnecessary trauma during the surgery and ensuring the thorough removal of all epithelial tissue and foreign bodies.

The mucous cyst, a rare and delayed complication after rhinoplasty

INTRODUCTION

Rhinoplasty is frequently performed worldwide, and patients and surgeons both expect good cosmetic results without any deformity recurrence. We report a rare case of mucous cyst occurred after post-traumatic rhinoseptoplasty.

OBSERVATION

A 27-year old woman presented a median mass of the nose root 7 years after prior rhinoseptoplasty. Investigations showed a subcutaneous lesion of 10.5×24.5mm. The surgery consisted on an external rhinoplasty allowing cyst removal, bilateral osteotomies and reconstruction of the nasal dorsum by deep temporal fascia graft. Histological examination confirmed the diagnosis of begnin mucous cyst. No recurrence was observed at 1-year follow-up.

DISCUSSION

Mucous cyst post rhinoplasty is rare and is probably due to accidental mucosal material implantation into the subcutaneous plane during rhinoplasty. This complication can be avoided by adequate infiltration and hydrodissection, careful dissection, and avoidance of unnecessary trauma during osteotomies.

Factors associated with postrhinoplasty mucous cyst in cleft lip patients

PURPOSE

The purpose of this study was to identify risk factors associated with postrhinoplasty mucous cyst (PMC) among adult cleft patients undergoing rhinoplasty. PMC has been reported sporadically in the literature. Its aetiology is uncertain. The purpose of this study was to determine whether three factors, (1) patient age, (2) surgical trauma, and/or (3) use of a nasal septal cartilage graft (NSCG), were risk factors for PMC.

METHODS

We organized a retrospective, single-center study and enrolled cleft rhinoplasty patients treated between January 2003 and December 2008. The predictor variables included age at surgery, use of a NSCG, and length of surgery. The primary outcome was presence of PMC. Other study variables included demographic, surgical, and postoperative data. Appropriate descriptive and univariate statistics were calculated, and P < 0.05 was regarded as indicative of statistical significance.

RESULTS

The sample comprised 314 cleft rhinoplasty patients (118 females; 37.6 %) with a mean age of 14.9 ± 10.7 years (range 0-65). Three patients had a PMC after secondary cleft rhinoplasty. Average time to disease was 26 ± 19.3 months after surgery (range 12-48). There was no significant association between the presence of the PMC and the three predictor variables-patient's age, NSCG transplantation, and protracted surgery (P > 0.05).

CONCLUSIONS

These study findings suggest that young age, use of a NSCG, and protracted surgery are not risk factors for PMC. The prevalence of PMC is greater for cleft patients after rhinosurgery than for noncleft patients.

A case of eyelid paraffinoma that developed after endoscopic sinus surgery

Paraffin has been used as a liquid prosthesis for medical purposes, and is still the base material in some ointments. However, it sometimes causes foreign-body reaction resulting in paraffinoma. We present a case of paraffinoma in a 64-year-old woman, which occurred in the eyelid after endoscopic sinus surgery for chronic sinusitis. During surgery, a small perforation developed in the left lamina papyracea, and therefore tetracycline ointment gauze was inserted. Two days after discharge, her left eyelid became swollen. The result of an open biopsy was paraffinoma. Total resection of the tumor was performed, and at the time of writing there has been no recurrence for 1 year after surgery.

Mucous cysts of the nose: a postrhinoplasty complication?: a long-term follow-up

Mucous cysts are very rare complications following rhinoplasty; less than 20 cases have been reported in literature. We present 2 new cases. The first case presented a cyst located beneath the glabella and above the articulation between the spina nasalis and the os nasale. The lesion first appeared 22 months following elective rhinoplasty. The treatment was complete surgical excision using a direct open approach. In the second case, a cyst was indentified between the right inner canthus and the sidewall of the nose. It appeared 6 months following elective rhinoplasty. The treatment was complete surgical excision through a transcartilaginous approach. Both patients had good postoperative results with no evidence of recurrence after a 7- and 8-year follow-up period, respectively. We believe that it is possible to prevent the appearance of mucous cysts after rhinoplasty, with careful dissection and avoidance of dispersion of mucosal material into a subcutaneous plane.

Prevention and management of rhinoplasty complications

LEARNING OBJECTIVES

After studying this article, the participant should be able to: 1. Identify potential hemorrhagic, infectious, traumatic, functional, or aesthetic complications arising from rhinoplasty. 2. Gain a better understanding of the prevention of these complications. 3. Have a thorough knowledge of the principles of postoperative management of these complications, so as to minimize their deleterious effects and preserve aesthetic outcomes in rhinoplasty.

SUMMARY

Meticulous attention to detail in the operating room and in the postoperative period is paramount to achieving success in rhinoplasty. Nevertheless, both complications and suboptimal results do occur, even for experienced surgeons.

Inclusion mucous cysts of the nose: a late complication after septorhinoplasty in two cleft lip patients

BACKGROUND

Mucous cysts of the nose are a rare complication of rhinoplasty. They may develop as a result of implantation or herniation of mucosa. The entrapped epithelium may proliferate, forming a subcutaneous cyst.

PATIENTS AND METHODS

Two patients with unilateral cleft lip nose deformity had previously undergone corrective rhinoplasty. Years after the operation, they noticed a growing mass in the nasal dorsum and presented for revision rhinoplasty. Complete surgical removal was performed by an open approach, and plastic reconstruction was performed with a rib cartilaginous graft.

RESULTS

In both cases, histopathological investigation revealed a mucous cyst. No recurrence of disease was observed over 2 years of monitoring.

CONCLUSION

Nasal mucous cysts are not specific complications of corrective surgery for cleft lip nose. Displacement of fragments of epithelium should be avoided to prevent this unwanted sequela. For complete removal, open rhinoplasty is recommended.

Nasal dorsal granuloma after nasal bone fracture

SUMMARY

A granuloma on the nasal dorsum after nasal bone fracture is a rare complication, like postrhinoplasty nasal cysts which were previously rarely reported. The authors describe five cases of nasal dorsal granuloma following nasal bone fracture reduction. Rubbery hard non-tender fixed masses were noted in the nasal root area 1 to 10 months after nasal bone reduction. The masses were managed by excision using a direct percutaneous approach. Histopathologic findings were of chronic granulomatous inflammation with infiltrations of epitheloid cells and Langerhans' giant cells and necrosis-like tuberculous tubercles. Acid-fast bacilli (AFB) stains were negative. The exact cause of this granuloma is not known, but imbedded free mucosal fragment or effused antibiotic ointment of packed gauze through the fracture site, which could cause a tissue reaction, is thought to be the cause of the granuloma. In order to prevent this rare complication, we recommend that aggressive practices and overpacking should be avoided during nasal bone reduction.

BMP-14 gene therapy increases tendon tensile strength in a rat model of Achilles tendon injury

BACKGROUND

Molecular and cellular-based enhancements of healing combined with conventional methods may yield better outcomes after the surgical management of tendon injury. We examined the histological and biomechanical effects of adenovirus-mediated transgene expression of bone morphogenetic protein-14 (BMP-14) on healing in a rat Achilles tendon laceration model. Specifically, we hypothesized that this delivery system for gene therapy would hasten the restoration of the normal histological appearance and tensile strength of a surgically repaired tendon.

METHODS

The right Achilles tendon of ninety male Sprague-Dawley rats was transected, repaired, and immediately infected with adenovirus expressing either the gene for green fluorescent protein (AdGFP) or the gene for human BMP-14 and green fluorescent protein (AdBMP-14). A sham control group received no viral-mediated infection after repair. Animals from each of the three groups were killed at one, two, and three weeks after surgery. The retrieved tendons were inspected, examined under light and fluorescent microscopy, and tested to determine their tensile strength.

RESULTS

Tendons transduced with BMP-14 exhibited less visible gapping, a greater number of neotenocytes at the site of healing, and 70% greater tensile strength than did either those transduced with GFP or the sham controls at two weeks after repair. Histological examination revealed no inflammatory response to the adenovirus in tendons transduced with BMP-14 or GFP. No ectopic bone or cartilage formed in the tendons transduced with BMP-14.

CONCLUSIONS

Adenovirus-mediated gene therapy with BMP-14 expedites tendon-healing in this animal model. No adverse immunological response to the adenoviral vector was detected in the host tissue, and the local production of BMP-14 did not induce unwelcome bone or cartilage formation within the healing tendon.

CLINICAL RELEVANCE

The results of this animal study suggest that gene therapy with BMPs may improve the capacity of injured musculoskeletal tissue to heal.

Tendon injury and tendinopathy: healing and repair

Tendon disorders are frequent and are responsible for substantial morbidity both in sports and in the workplace. Tendinopathy, as opposed to tendinitis or tendinosis, is the best generic descriptive term for the clinical conditions in and around tendons arising from overuse. Tendinopathy is a difficult problem requiring lengthy management, and patients often respond poorly to treatment. Preexisting degeneration has been implicated as a risk factor for acute tendon rupture. Several physical modalities have been developed to treat tendinopathy. There is limited and mixed high-level evidence to support the, albeit common, clinical use of these modalities. Further research and scientific evaluation are required before biological solutions become realistic options.