Giant Rhinophyma: A Rare Case of Total Nasal Obstruction and Restitutio Ad Integrum

Abstract

Rhinophyma is considered the end stage in the development of rosacea, accompanied by hypertrophy of the sebaceous glands, which causes an enlargement of the nose. It is an uncommon condition that often results in both functional and cosmetic impairment. A large variety of surgical and nonsurgical treatments have been published to treat it. Closure is usually obtained by wound granulating in by secondary intention, skin grafting or local flaps. Rarely these lesions can attain a giant size and pose a challenge in surgical treatment. We present a 63-year-old male with the necessity for tracheostomy at the ICU due to total nasal obstruction and recurrent episodes of pneumonia caused by a huge giant rhinophyma, which had undergone extreme growth in the last five years. The tumor was removed under general anesthesia by decortication with an electrosurgical wire loop to recreate the aesthetic units of the nose preserving the alar cartilage as well as the pilosebaceous appendages. The wounds healed in by secondary intention with a very pleasant cosmetic and improved functional result. The relevant literature is discussed. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Systematic Review of Surgical Techniques for Management of Severe Rhinophyma

“…18 Additionally, 3 case studies discussing treatment of severe rhinophyma with electrocautery reported re-epithelialization times between 2 and 4 weeks. 19,20,31 All studies reported good hemostasis and the added benefits of short surgical times and cost-effectiveness. 16 –18,20,21…”

“…They discuss the ability to preserve the alar cartilage and deep pilosebaceous tissue with the use of electrocautery, which allows for recreation of the aesthetic subunits of the nose. 31 However, due to the intense heat generated during excision with electrocautery, there is an added risk of damage to the underlying cartilaginous structure, potentially prolonging scarring or necrosis. 32,33…”

“…They discuss the ability to preserve the alar cartilage and deep pilosebaceous tissue with the use of electrocautery, which allows for recreation of the aesthetic subunits of the nose. 31 However, due to the intense heat generated during excision with electrocautery, there is an added risk of damage to the underlying cartilaginous structure, potentially prolonging scarring or necrosis. 32,33 Somogyvári et al reported Visual Analog Scores (VAS) on a scale of 1-10 to objectively rate cosmetic appearances preoperatively to 3 months postoperatively for patients treated with electrosurgical excision of rhinophyma.…”

Surgical treatment of rhinophyma using an ordinary bur

“…Rhinophyma is a rare and painless benign tumor of the skin of the nose characterized by hyperplasia of the sebaceous glands, connective tissue, and blood vessels [1]. Rhinophyma is generally confined to the lower nose and does not involve the bone or cartilage framework.…”

A case report of giant rhinophyma

“…Rhinophyma is a rare, disfiguring disease characterized by a progressive hypertrophy of the soft-tissues of the nose with its increased volume, mainly in the lower half, and often associated to an end-stage of severe acne rosacea [1]. In literature only 18 cases of giant rhinophyma are described [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] (Table 1).…”