Endoscopic Removal of Subcutaneous Pyogenic Granuloma of the Nasal Radix

Abstract

Objective: This case report describes the removal of a subcutaneous pyogenic granuloma (lobular capillary hemangioma) on the left nasal bone in a 51-year-old woman. A minimally invasive surgical approach using rhinoplasty techniques combined with endoscopes is described, along with indications and contraindications for use.

Method: The nontender nasal mass developed over 5 weeks. It was soft like a lipoma and clearly subcutaneous with no visible puncta or cutaneous irregularity, and was lateral to the nasal bones between radix and rhinion. The patient wanted to avoid a skin incision at all costs.

Results: Under anesthesia, an intercartilagenous incision was made and sharp dissection over the upper lateral cartilage and nasal bone was performed to approach the mass. Using endoscopes and dissectors, the mass was removed with a cuff of soft tissue. It appeared blue and grossly consistent with a vascular neoplasm. Frozen section evaluation was nondiagnostic. Final histopathology showed the characteristic lobular configuration with a central branching vessel with solid growth pattern of endothelial proliferation. At 12 weeks no contour defect along lateral nasal sidewall was appreciated. The indications and limitations of this minimally invasive approach will be discussed.

Conclusion: This presentation of a pyogenic granuloma is rare and unusual. An endonasal rhinoplasty approach utilizing endoscopy instrumentation spared the patient a cutaneous scar. This approach should be considered for patients with similar deep subcutaneous benign neoplasms over the osseous or cartilage nasal framework as it spares a visible incision.