Dorsal Nasal Mucocele: A Delayed Complication of Rhinoplasty

Abstract

Objective: To describe an interesting case of a subcutaneous dorsal nasal mucocele that developed 21 years after primary endonasal rhinoplasty and to list methods by which this delayed complication can be avoided.

Method: A 51-year-old man presented with a 2-year history of a slowly growing asymptomatic mass on the nose which was lateral to midline, cephalic to the lower lateral cartilages, and superficial to the upper lateral cartilage while remaining deep to the subcutaneous tissues.

Results: Fine needle aspiration was performed and was nondiagnostic, as only epithelial cells were identified. Imaging studies indicated a 1-cm low-density, difficult-to-characterize nodule on the inner aspect of the right nostril. The patient was taken to surgery, and an open rhinoplasty approach was used to access the mass. It was a well-demarcated, globular, fluid-containing cystic structure that did not track to the skin or vestibular surface. The differential diagnosis for nasal lesions in this area include inclusion cysts, benign skin adnexal tumors, dermoid cysts, encephaloceles, and minor salivary gland neoplasms. Pathology demonstrated findings consistent with mucocele.

Conclusion: It is likely that the patient had mucosal tissue from the nasal vault trapped subcutaneously during rhinoplasty. Over years, this grew to become cosmetically symptomatic. Prevention of this rare long-term complication of rhinoplasty requires well-defined incisions and meticulous attention to wound closure. Treatment herein was via an open rhinoplasty approach.