Open rhinoplasty and nasal dorsal leiomyoma:case report

Objective: To describe the surgical management of a leiomyomaof the nasal dorsum.Clinical case: A 50 years-old man was referred with a slow progressiveasymptomatic swelling of the nasal dorsum. History wasnegative for frontonasal trauma, infection or previous surgery.Clinical examination revealed an asymmetric subcutaneousslightly mobile mass of the nasal dorsum; there was not evidenceof cutaneous sinus. Intranasal examination detected a mass protrudinginto the right vestibulum, covered by pink mucosa.RM demonstrated a well-circumscribed mass consistent withfibroma or leiomyoma extending into the upper portion of thenasal septum.Open septorhinoplasty was performed. A stair-step columellarincision was made, the lower and upper lateral cartilage weredelimited. The mass was dissected from both the upper lateralcartilage and the underside of the nasal bones with completeexcision of the mass. The defect was curetted. Two paraseptalspreaders grafts, taken from septum, were sutured transeptal. Alarremodelling and interdomal suture were performed.Histopathologic analysis was consistent with a leiomyoma(size 2.3 cm×2 cm×2.5 cm). Postoperative clinical examinationshowed a good esthetic result; no complications or recurrenceoccurred at 22 months of follow-up.Conclusion: The use of an open septorhinoplasty may appearan invasive approach for the benign nature of the lesion, but itrevealed to be a suitable technique to immediately overcome thenegative consequence of the surgical dissection over the sub-nasalstructures preserving both function and aesthetic of the nose