LIPOGRANULOMAS AS COMPLICATIONS OF SEPTORHINOPLASTY

Background: Nasal tumors caused by lipogranulomas are a rare complicat ion of a rhinoplasty; only 1 report of this occurrence was found in th e literature. Objective: To present a series of 4 patients with subcut aneous nasal tumors after each had undergone a rhinoplasty, together w ith a review of the literature and the clinical consequences. Design: Case series. Setting: Hospitalized care at a university ear, nose, and throat department. Patients: Four patients were referred within 6 mon ths from a single department for consultation because of broad nasal p yramids after each patient had undergone a rhinoplasty. The origin of the deformities was not known. Interventions: Ear, nose, and throat an d ultrasound examinations and computed tomography tie, bone and soft t issue examinations). Two patients had undergone revision surgery and h istological examinations of subcutaneous fibrous tissue. Main Outcome Measurer Search for the origin of the nasal deformity. Results: All 4 patients had wide nasal pyramids. One of the 4 patients also had subcu taneous tumors of the nasal dorsum, glabella, and medial canthus area; this patient had subcutaneous cystic lesions on computed tomography a nd ultrasound examination and a foreign body reaction around ''empty s paces'' on histological examination. The tumorlike lesions were the re sult of displaced ointment from the endonasal packings. Two of the 4 p atients with minor deformities did not undergo any surgical revision, and they still had some moderate reduction of the cystic lesions withi n 1 year after the rhinoplasty. Conclusions: Lipogranulomas caused by ointments that are used together with nasal packings are most often re ported in the orbit after endonasal sinus surgery. The incidence shoul d be more frequent in patients who undergo a rhinoplasty because conne ctions between the endonasal cavity and the extranasal subcutaneous la yer are created routinely by osteotomies or removal of a hump. Thus, p ostoperative deformities leg, inadequate narrowing of the bony pyramid or supratip thickening [permanent swelling of the nasal tip]) should be examined by use of computed tomography, if lipid ointments were use d endonasally. For prevention, no lipid substances should be applied t ogether with pressure from packings. In the case of a lipogranuloma, s urgical removal via an open approach is the treatment of choice.