Rettinger G, Steininger H
Ear-Nose and Throat Department, University Ulm, Germany.
Arch Otolaryngol Head Neck Surg. 1997 Aug;123(8):809-14. doi: 10.1001/archotol.1997.01900080041003.
Nasal tumors caused by lipogranulomas are a rare complication of a rhinoplasty; only 1 report of this occurrence was found in the literature.
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.
Case series.
Hospitalized care at a university ear, nose, and throat department.
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.
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.
Search for the origin of the nasal deformity.
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.
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.
脂肪肉芽肿引起的鼻腔肿瘤是隆鼻手术罕见的并发症；文献中仅发现1例相关报道。
报告4例隆鼻术后出现皮下鼻腔肿瘤的患者，并对文献及临床后果进行综述。
病例系列。
某大学耳鼻喉科的住院治疗。
4例患者在隆鼻术后因鼻背变宽，于6个月内由同一科室转诊进行咨询。畸形的原因不明。
耳鼻喉检查、超声检查及计算机断层扫描（即骨骼和软组织检查）。2例患者接受了修复手术及皮下纤维组织的组织学检查。
寻找鼻畸形的根源。
4例患者均有鼻背变宽。4例患者中有1例鼻背、眉间及内眦区域也出现皮下肿瘤；该患者在计算机断层扫描和超声检查中发现皮下囊性病变，组织学检查显示“空隙”周围有异物反应。肿瘤样病变是鼻内填充物中药膏移位所致。4例畸形较轻的患者中有2例未进行任何手术修复，隆鼻术后1年内囊性病变仍有一定程度的减轻。
鼻内填充物使用的药膏引起的脂肪肉芽肿最常见于鼻内鼻窦手术后的眼眶。隆鼻患者的发病率可能更高，因为鼻内截骨术或驼峰切除手术通常会建立鼻内腔与鼻外皮下层之间的连接。因此，如果鼻内使用了脂质药膏，术后畸形（如骨锥变窄不足或鼻尖增厚[鼻尖永久性肿胀]）应通过计算机断层扫描进行检查。为预防起见，不应在有填充物压力的情况下同时使用脂质物质。对于脂肪肉芽肿，采用开放手术切除是首选治疗方法。
