Removal of a nasal bone intraosseous venous malformation and primary reconstruction of the surgical defect using open rhinoplasty

Abstract

Primary intraosseous venous malformations are rare benign tumors that account for approximately 1% of all primary osseous tumors. They are rarely found in the midface. The authors report a case of an intraosseous venous malformation in a 28-year-old woman who presented with a bony lesion in the nasal bone. Treatment involved surgical excision via open rhinoplasty. Histopathology indicated an intraosseous venous malformation. 16 months postoperatively, there was no evidence of recurrence, the functional and cosmetic results were good, and the patient was satisfied with the treatment outcome.

Hemangiomas arising in the soft tissue of the head and neck are a common type of tumor. In contrast, intraosseous venous malformations are rare slow-growing benign tumors that comprise 0.5–1% of all osseous tumors . Midfacial involvement is extremely rare, with the maxilla and mandible the most commonly affected sites . Owing to its rarity, most reports of intraosseous venous malformation of the nasal bone describe a single case, and there is no consensus regarding reconstruction of nasal defects following surgical removal of these tumors.

The present report describes a case of a nasal bone intraosseous venous malformation treated by excision and primary reconstruction using an open rhinoplasty approach. To the authors’ knowledge, this is the first report describing treatment of this condition.

Case report

A 25-year-old woman presented with a 5-year history of a slow-growing painless mass involving the left nasal bone ( Fig. 1 ). The patient complained of mild tenderness on the left nasal dorsum and of cosmetic issues. There were no rhinologic symptoms such as nasal obstruction or decreased facial sensation, and no history of surgery or trauma. Physical examination demonstrated a 1.5-cm hard protruding mass in the left nasion. A computed tomography (CT) scan of the facial bone showed a lytic bony lesion involving the left nasal bone. The mass had a honeycomb appearance that was clearly distinct from the surrounding bony tissue ( Fig. 2 ).

Fig. 1
A 25-year-old woman with a slowly enlarging nasal dorsum bone mass. Preoperative view (left). Postoperative view at 9 months after surgery (right).

Fig. 2
Preoperative CT scans. Axial (left) and coronal (right) sections showing the honeycomb pattern (arrow) of the tumor involving the left nasal bone. There were no signs of adjacent tissue destruction.

The patient underwent complete excision of the nasal mass via open rhinoplasty under general anesthesia. A transcolumellar incision was made as an ‘inverted V shape’, and the incision was extended around the caudal edge of the lateral crus and cut the marginal incision. Continued elevation of the skin flap over the nasal dorsum exposed the bony mass lesion and the surrounding cartilaginous vault. The bony mass had a core composed of bony trabeculae, which had a honeycomb pattern, was friable, and had a very low blood flow. Intraoperative frozen biopsy results on the mass indicated a benign bone tumor. The tumor was excised completely endoscopically using cutting forceps until healthy bone was exposed. Removal of the mass affected the projection of the nasal dorsum. The nasal dorsum defect was reconstructed using two pieces of autologous septal cartilage harvested during flap elevation. The cartilage grafts were inserted on the bony vault cephalically and the upper lateral cartilages caudally. Complete lateral osteotomies were performed, and a spreader graft was positioned bilaterally ( Fig. 3 ). Tutoplast-processed fascia lata (Tutoplast ® , Germany; 30 mm × 40 mm) was used to smooth dorsal irregularities following tumor excision.

Feb 8, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Removal of a nasal bone intraosseous venous malformation and primary reconstruction of the surgical defect using open rhinoplasty
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