Oral Maxillofac Surg (2015) 19:391–396 DOI 10.1007/s10006-015-0510-9
ORIGINAL ARTICLE
Factors associated with postrhinoplasty mucous cyst in cleft lip patients Niels Christian Pausch 1 & Dirk Halama 1 & Kittipong Dhanuthai 2 & Keskanya Subbalekha 3 & Jörg Hendricks 1
Received: 9 March 2015 / Accepted: 18 May 2015 / Published online: 30 May 2015 # Springer-Verlag Berlin Heidelberg 2015
Abstract Purpose The purpose of this study was to identify risk factors associated with postrhinoplasty mucous cyst (PMC) among adult cleft patients undergoing rhinoplasty. PMC has been reported sporadically in the literature. Its aetiology is uncertain. The purpose of this study was to determine whether three factors, (1) patient age, (2) surgical trauma, and/or (3) use of a nasal septal cartilage graft (NSCG), were risk factors for PMC. Methods We organized a retrospective, single-center study and enrolled cleft rhinoplasty patients treated between January 2003 and December 2008. The predictor variables included age at surgery, use of a NSCG, and length of surgery. The primary outcome was presence of PMC. Other study variables included demographic, surgical, and postoperative data. Appropriate descriptive and univariate statistics were calculated, and P < 0.05 was regarded as indicative of statistical significance. Results The sample comprised 314 cleft rhinoplasty patients (118 females; 37.6 %) with a mean age of 14.9±10.7 years (range 0–65). Three patients had a PMC after secondary cleft
* Niels Christian Pausch [email protected] 1
Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, Faculty of Medicine, University Hospital of Leipzig, Leipzig, Germany
2
Department of Oral Pathology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
3
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University Bangkok, Bangkok, Thailand
rhinoplasty. Average time to disease was 26±19.3 months after surgery (range 12–48). There was no significant association between the presence of the PMC and the three predictor variables—patient’s age, NSCG transplantation, and protracted surgery (P>0.05). Conclusions These study findings suggest that young age, use of a NSCG, and protracted surgery are not risk factors for PMC. The prevalence of PMC is greater for cleft patients after rhinosurgery than for noncleft patients. Keywords Mucous cyst . Cleft rhinoplasty . Risk factor . Postsurgery complication
Introduction Postrhinoplasty mucous cyst (PMC) has been reported sporadically [1–6]. McGregor et al. first described PMC in 1958 and hypothesized that it resulted from mucosal herniation through the osteotomy line [1]. In 1970, Mouly reported two cases of PMC in the French surgical literature and suggested that the main cause of PMC was entrapment of nasal mucosa [2]. For most reported cases, however, no direct connection between the nasal mucosa and the cyst was observed [4, 5], and the aetiology of PMC is unknown. The time before development of PMC ranges from the first week after surgery to several decades [6]. It can occur on any part of the nose, medial canthus, nasal tip, glabella, or paranasal region, and after either first or revision rhinoplasty [4, 7, 8]. We recently reported two PMC cases; both underwent secondary cleft rhinoplasty with a nasal septal cartilage graft (NSCG) [9]. In 2001, the French Society of Plastic, Reconstructive, and Aesthetic Surgery recommended to its members that
392
rhinoplasty candidates should be informed about the risk of PMC [10]. In a forceful effort, the German Associations of Oral and Maxillofacial Surgery and Otolaryngology have, together, prepared a brochure and written consent for rhinoplasty patients, including details of the surgical procedure and its complications. Unfortunately, PMC is not mentioned in this brochure; so, many surgeons have not discussed this lesion when obtaining patient consent. Possible explanations are that the pathogenesis and causes of PMC are inconclusive, and the lesion is very rare and unrecognized by many rhinoplastic surgeons. The purpose of this study was to identify the risk factors associated with PMC among patients who undergo secondary cleft nose correction. We hypothesized that PMC might be associated with the following: (1) being relatively young (
ORIGINAL ARTICLE
Factors associated with postrhinoplasty mucous cyst in cleft lip patients Niels Christian Pausch 1 & Dirk Halama 1 & Kittipong Dhanuthai 2 & Keskanya Subbalekha 3 & Jörg Hendricks 1
Received: 9 March 2015 / Accepted: 18 May 2015 / Published online: 30 May 2015 # Springer-Verlag Berlin Heidelberg 2015
Abstract Purpose The purpose of this study was to identify risk factors associated with postrhinoplasty mucous cyst (PMC) among adult cleft patients undergoing rhinoplasty. PMC has been reported sporadically in the literature. Its aetiology is uncertain. The purpose of this study was to determine whether three factors, (1) patient age, (2) surgical trauma, and/or (3) use of a nasal septal cartilage graft (NSCG), were risk factors for PMC. Methods We organized a retrospective, single-center study and enrolled cleft rhinoplasty patients treated between January 2003 and December 2008. The predictor variables included age at surgery, use of a NSCG, and length of surgery. The primary outcome was presence of PMC. Other study variables included demographic, surgical, and postoperative data. Appropriate descriptive and univariate statistics were calculated, and P < 0.05 was regarded as indicative of statistical significance. Results The sample comprised 314 cleft rhinoplasty patients (118 females; 37.6 %) with a mean age of 14.9±10.7 years (range 0–65). Three patients had a PMC after secondary cleft
* Niels Christian Pausch [email protected] 1
Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, Faculty of Medicine, University Hospital of Leipzig, Leipzig, Germany
2
Department of Oral Pathology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
3
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University Bangkok, Bangkok, Thailand
rhinoplasty. Average time to disease was 26±19.3 months after surgery (range 12–48). There was no significant association between the presence of the PMC and the three predictor variables—patient’s age, NSCG transplantation, and protracted surgery (P>0.05). Conclusions These study findings suggest that young age, use of a NSCG, and protracted surgery are not risk factors for PMC. The prevalence of PMC is greater for cleft patients after rhinosurgery than for noncleft patients. Keywords Mucous cyst . Cleft rhinoplasty . Risk factor . Postsurgery complication
Introduction Postrhinoplasty mucous cyst (PMC) has been reported sporadically [1–6]. McGregor et al. first described PMC in 1958 and hypothesized that it resulted from mucosal herniation through the osteotomy line [1]. In 1970, Mouly reported two cases of PMC in the French surgical literature and suggested that the main cause of PMC was entrapment of nasal mucosa [2]. For most reported cases, however, no direct connection between the nasal mucosa and the cyst was observed [4, 5], and the aetiology of PMC is unknown. The time before development of PMC ranges from the first week after surgery to several decades [6]. It can occur on any part of the nose, medial canthus, nasal tip, glabella, or paranasal region, and after either first or revision rhinoplasty [4, 7, 8]. We recently reported two PMC cases; both underwent secondary cleft rhinoplasty with a nasal septal cartilage graft (NSCG) [9]. In 2001, the French Society of Plastic, Reconstructive, and Aesthetic Surgery recommended to its members that
392
rhinoplasty candidates should be informed about the risk of PMC [10]. In a forceful effort, the German Associations of Oral and Maxillofacial Surgery and Otolaryngology have, together, prepared a brochure and written consent for rhinoplasty patients, including details of the surgical procedure and its complications. Unfortunately, PMC is not mentioned in this brochure; so, many surgeons have not discussed this lesion when obtaining patient consent. Possible explanations are that the pathogenesis and causes of PMC are inconclusive, and the lesion is very rare and unrecognized by many rhinoplastic surgeons. The purpose of this study was to identify the risk factors associated with PMC among patients who undergo secondary cleft nose correction. We hypothesized that PMC might be associated with the following: (1) being relatively young (
