Tumefactive cartilage proliferation after rhinoplasty: A newly reported complication

Objective: To describe and document the development of tumoral proliferation of cartilage in 4 patients after nasal surgery, a complication that, to our knowledge, has not been reported before. Design: Similar postoperative nasal masses were excised from 4 patients who underwent rhinoplasty. Histopathologic evaluation was carried out to identify the nature of the lesions and to provide a basis for rational management of similar lesions subsequently encountered. Setting: Academic tertiary referral center. Participants: Four healthy patients (3 women and 1 man) ranging in age from 21 to 49 years. Two of the patients underwent routine rhinoplasty with resection of cephalic margins of alar cartilages, and 2 underwent augmentation procedures with implantation of auricular cartilage. Intervention: Discrete firm masses were excised from each patient's nose approximately 1 year after the most recent rhinoplastic procedure was performed. Histological evaluation was carried out on each specimen. Results: All 4 masses were found to consist of tumefactive proliferation of cartilage. Clonal proliferation and mild nuclear atypia were observed. Conclusions: After rhinoplasty, progressive asymmetrical fullness in or adjacent to cartilaginous structures or graft material should suggest the possibility of tumefactive proliferation of cartilage and should be evaluated with surgical exploration. All areas of thickened cartilage should be excised completely, with immediate auricular cartilage reconstruction of resulting anatomical defects. Perichondrium should be completely removed from auricular cartilage implants in the nose, and mechanical injury to the graft should be minimized. We strongly caution against morsellizing dorsal cartilage implants for nasal reconstruction.