A Rare Late Complication of Rhinoplasty: Dorsal Nasal Cyst
18 November 2015 (online)
Dorsal nasal cyst formation after rhinoplasty is a rare complication. There are few cases known in the literature. Most of the cases are mucoceles. Half of the cases were dorsally localized, whereas some were seen on alar cartilages and nasal tip. Very few cases reported localized on glabella. A total of 26 cases were published in the literature. Mucosal tissue migration with bone and cartilage segments is likely the cause of the problem. It is considered that mucocele is the result of replacing respiratory epithelium and ectopic regrowing after rhinoplasty. On the other hand, there are cases published about occurring due to foreign bodies such as silicone implants and latex. Another rare cause of dorsal nasal cyst is cleft lip nose deformity surgery. A 32-year-old male was referred to our clinic complaining about an asymptomatic growing mass on the dorsum of his nose. He had rhinoplasty 14 years ago. There was not any trauma before and after the operation and he did not have any kind of infection, drainage, or another problem with his nose. He observed a mass on the left side of his dorsum 10 years after his rhinoplasty and that mass grew in time. He had a 2 × 2 cm sized, semimobile mass on the left side of his nasal bone ([Fig. 1a,b]). Computed tomographic (CT) scan demonstrated a 15 × 14 mm sized low-density mass which was located on the left upper lateral cartilage and destructed the nasal bone on the left side ([Fig. 2a]). The specimen was smooth and capsulated and 14 × 13 mm in size ([Fig. 2b]). The patient was operated on general anesthesia. An incision was made on the dorsum and the cyst capsule was clearly seen and discarded by a gentle dissection. The cyst has destructed the nasal bone and upper lateral cartilages. The depression on the nasal dorsum was still there after 3 months postoperatively ([Fig. 1c,d]). Rhinoplasty is one of the most popular aesthetic operations throughout the world. Patient expectation is to achieve the best result after surgery. Tissue edema, skin necrosis, infection, and hypoesthesia on the tip are frequent complications after rhinoplasty. Mucocele formation is a very few complication. The only therapy is surgical excision of the cyst and the best surgical approach is the open rhinoplasty incision or skin incision through the cyst for the dorsal and radix localized ones. Although dorsal nasal cyst is a rare complication, it is one of the preventable complications. The best way of prevention is to avoid migration of the mucosal epithelium through the osteotomy lines. Mucosal tissue must be cleaned off the cartilages clearly, which will be used as grafts. The cartilages must be shaved in a good way. We must pay attention not to tear the surgical gloves. The grafts must be autograft which will be used during rhinoplasty. We must not use foreign bodies made of silicon or other materials. It is obvious that this rare complication will be seen less if we take these measures.