Epidermal Cyst of the Nasal Tip Presenting as Foreign Body Reaction

Choi, Chang Yong; Choi, Hwan Jun

Abstract

PURPOSE
Epidermoid cyst may be congenital or acquired. Acquired cysts are most commonly of traumatic origin and result from an implantation or downward displacement of an epidermal fragment. Traumatic epidermoid cysts are rare tumors occurring on the nasal tip, especially resulting aesthetic procedure. So, we report a rare case of an iatrogenic epidermoid cyst in the nasal tip following rhinoplasty.
METHODS
A 44-year old man had undergone rhinoplasty for several times. First time, the previous augmentation rhinoplasty and wedge osteotomy were performed nineteen months ago, lastly implant removal and unknown filler injection were performed one year ago at another local clinic. He had induration and tenderness on nasal tip and dorsum continued for 3 months. We thought that it was caused by the foreign body reaction with residual alloderm in nose. For removal of residual alloplastic material, open approach using transcolumellar incision was done. But, incidentally we found cystic mass on the nasal tip.
RESULTS
The findings were of an 0.8x0.5x0.5cm sized round cystic mass containing cream coloured material with a thick cheese-like consistency. The mass was completely excised and submitted for histology. This confirmed the diagnosis of an epidermoid cyst lined by keratinizing squamous epithelium. There was no induration, tenderness or sign of recurrence after excision of the mass.
CONCLUSION
Epidermal cyst of the nasal tip region represents an unusual clinical lesion and it presents as foreign body reaction. And then, our case demonstrates that meticulous surgical approach and suture technique are the keys to prevent iatrogenic nasal epidermoid cyst, especially in secondary rhinoplasty.