Lipogranulomas as complications of septorhinoplasty

BACKGROUND: Nasal tumors caused by lipogranulomas are a rare complication of a rhinoplasty; only 1 report of this occurrence was found in the literature.

OBJECTIVE: To present a series of 4 patients with subcutaneous nasal tumors after each had undergone a rhinoplasty, together with 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 months from a single department for consultation because of broad nasal pyramids after each patient had undergone a rhinoplasty. The origin of the deformities was not known.

INTERVENTIONS: Ear, nose, and throat and ultrasound examinations and computed tomography (ie, bone and soft tissue examinations). Two patients had undergone revision surgery and histological examinations of subcutaneous fibrous tissue.

MAIN OUTCOME MEASURE: Search for the origin of the nasal deformity.

RESULTS: All 4 patients had wide nasal pyramids. One of the 4 patients also had subcutaneous tumors of the nasal dorsum, glabella, and medial canthus area; this patient had subcutaneous cystic lesions on computed tomography and ultrasound examination and a foreign body reaction around "empty spaces" on histological examination. The tumorlike lesions were the result of displaced ointment from the endonasal packings. Two of the 4 patients with minor deformities did not undergo any surgical revision, and they still had some moderate reduction of the cystic lesions within 1 year after the rhinoplasty.

CONCLUSIONS: Lipogranulomas caused by ointments that are used together with nasal packings are most often reported in the orbit after endonasal sinus surgery. The incidence should be more frequent in patients who undergo a rhinoplasty because connections between the endonasal cavity and the extranasal subcutaneous layer are created routinely by osteotomies or removal of a hump. Thus, postoperative deformities (eg, 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 used endonasally. For prevention, no lipid substances should be applied together with pressure from packings. In the case of a lipogranuloma, surgical removal via an open approach is the treatment of choice.