Mucous Cysts as a Complication of Rhinoplasty

Aesthetic and reconstructive surgery of the nose remains the most challenging and difficult of all head and neck plastic surgical operations. (Tardy, 1995) Rhinoplasty is considered as a highly demanding procedure. The nose is the most prominent part of the face and derogations may be less appropriate than deviations. Complications can refer either to the skeletal framework or to the soft-tissue regions and they can be divided into functional and aesthetical. According to the time of presentation they can be intraoperative or postoperative early or late complications. Implantation cysts and deforming masses are infrequent and very rare, but avoidable complications of rhinoplasty. Displacement of fragments of epithelium may result in subcutaneous graft entrapment and subsequent encystation. Epidermoid cysts or mucous cysts may be developed, depending on the type of epithelium trapped. They must be addressed with a thorough evaluation of the extent of the lesion to choose the most appropriate procedure for removal. Knowledge of the various capabilities and presentations of postrhinoplasty cysts, will better equip surgeons for a successful outcome. Although a mucous cyst is a benign lesion, it is considered to be a serious complication of rhinoplasty. Mucous cysts are presented in many locations and ages, with a wide range of concurrent symptoms. Most of them are appeared several months or years after rhinoplasty. Complete resection of the mucous cyst is the gold standard of treatment. Identification of involved structures will ensure appropriate procedure selection. Almost all the cases reported in the literature have been described as solitary lesions which were successfully eradicated following a single surgical procedure. There was only one paper reported a case of a patient who had presented two mucous cysts,the first one two months postoperatively and the second one five months after surgical extirpation (Mouly, 1970), and only two authors reported recurrence after surgical intervention. (Zijlker and Vuyk, 1993; Ntomouchtsis et.al. 2010) Regarding the high number of rhinoplasty procedures performed worldwide every year, the number of the 30 published cases is on the contrary very low. These observations make it possible that specific local conditions must exist before a mucous cyst may be expected to develop and one important factor is likely to be the size of the displaced epithelial fragment. There is also exists the possibility that all occurred complications have not been presented yet.