J Korean Med Sci.  2008 Dec;23(6):1109-1112. 10.3346/jkms.2008.23.6.1109.

Foreign Body Inclusion Cyst of the Nasal Radix after Augmentation Rhinoplasty

• Chang DY
• Jin HR

• KMID: 1107541
• DOI: http://doi.org/10.3346/jkms.2008.23.6.1109

Abstract

Development of a cystic mass on the nasal dorsum is a very rare complication of aesthetic rhinoplasty. Most reported cases are of mucous cyst and entrapment of the nasal mucosa in the subcutaneous space due to traumatic surgical technique has been suggested as a presumptive pathogenesis. Here, we report a case of dorsal nasal cyst that had a different pathogenesis for cyst formation. A 58-yr-old woman developed a large cystic mass on the nasal radix 30 yr after augmentation rhinoplasty with silicone material. The mass was removed via a direct open approach and the pathology findings revealed a foreign body inclusion cyst associated with silicone. Successful nasal reconstruction was performed with autologous cartilages. Discussion and a brief review of the literature will be focused on the pathophysiology of and treatment options for a postrhinoplasty dorsal cyst.

Keyword

Rhinoplasty; Inclusion; Cysts; Radix; Silicones; Complications

MeSH Terms

Cysts/diagnosis/pathology/surgery
Female
Foreign Bodies/diagnosis/*etiology
Humans
Microscopy, Electron, Scanning
Middle Aged
*Nose/pathology
Nose Diseases/diagnosis/etiology/pathology
Rhinoplasty/*adverse effects
Tomography, X-Ray Computed

Figure

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  Fig. 1 The preoperative photograghs (A: frontal view, B: lateral view) show a large cystic mass on the nasal radix. Photographs (C: frontal view, D: lateral view) taken 6 months after surgery show successfully removed nasal cyst with a good aesthetical result.

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  Fig. 2 On CT scan, there was a heterogeneous cystic mass at the radix and the cyst was continuous with a homogenous density at the nasal dorsum, which was first thought to be a silicone implant.

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  Fig. 3 (A) The removed cyst has a thick, fibrous wall and contains caseous materials inside. (B) Kidney-shaped foreign bodies that were stained light purple are scattered in the cytoplasm of the giant cells and interstitial tissues surrounded by inflammatory cells (H&E stain, ×200).

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  Fig. 4 (A) Scanning electron microscopy (SEM) shows a fragment of foreign body (indicated by the box). (B) Analysis with SEM-EDX (energy dispersive radiography) shows the presence of silicone in the removed specimen.

Reference

1. Pak MW, Chan ES, van Hasselt CA. Late complications of nasal augmentation using silicone implants. J Laryngol Otol. 1998. 112:1074–1077.

2. Harley EH, Erdman JP. Dorsal nasal cyst formation. A rare complication of cosmetic rhinoplasty. Arch Otolaryngol Head Neck Surg. 1990. 116:105–106.

3. White MI, Smart LM, Macgregor DM, Rayner CR, Smith FW. Recurrent facial oedema associated with a silicone-rubber implant. Br J Dermatol. 1991. 125:183–185.

4. Kotzur A, Gubisch W. Mucous cyst--a postrhinoplasty complication: outcome and prevention. Plast Reconstr Surg. 1997. 100:520–524.

5. Lawson W, Kessler S, Biller HF. Unusual and fatal complications of rhinoplasty. Arch Otolaryngol. 1983. 109:164–169.

6. Shulman Y, Westreich M. Postrhinoplasty mucous cyst of the nose. Plast Reconstr Surg. 1983. 71:421–422.

7. Kossovsky N, Freiman CJ. Silicone breast implant pathology. Clinical data and immunologic consequences. Arch Pathol Lab Med. 1994. 118:686–693.

8. Tang L, Lucas AH, Eaton JW. Inflammatory responses to implanted polymeric biomaterials: role of surface-adsorbed immunoglobulin G. J Lab Clin Med. 1993. 122:292–300.

9. Tham C, Lai YL, Weng CJ, Chen YR. Silicone augmentation rhinoplasty in an Oriental population. Ann Plast Surg. 2005. 54:1–7.

10. Wang TD. Non-Caucasian rhinoplasty. Facial Plast Surg. 2003. 19:247–256.

11. Yang J, Wang X, Zeng Y, Wu W. Biomechanics in augmentation rhinoplasty. J Med Eng Technol. 2005. 29:14–17.

12. Narins RS, Beer K. Liquid injectable silicone: a review of its history, immunology, technical considerations, complications, and potential. Plast Reconstr Surg. 2006. 118:3 Suppl. 77S–84S.

13. Fulton JE Jr, Porumb S, Caruso JC, Shitabata PK. Lip augmentation with liquid silicone. Dermatol Surg. 2005. 31:1577–1586.