Why a mass obstructing the nostril develops, and how to perform resection and reconstruction

Hello, I am Dr. Peter C. Kang.

Today, I would like to introduce the case of a patient who was told by multiple clinics that surgery was not feasible, but who achieved full resection of a nostril mass and recovered successfully.

First surgery - 2020

• Osteopore, G-Mesh → deformation

December 2020

Second surgery - 2021

• Removal of Osteopore and G-Mesh

• Ear cartilage graft → contracture

August 2021

August 2021

Third surgery - 2022

• Ear cartilage graft → deformation

May 2022

Fourth surgery - 2023

• Dermal fat graft (subumbilical)

• Onset of mass in the left nostril

December 2023

February 2024

Fifth surgery - 2024

• Attempted laser treatment

• Mass progressively enlarges

July 2024, 1 day after surgery

July 2024, 1 week after surgery

Patient information

• 27-year-old female

Primary concerns

• Mass obstructing the left nostril

• Lesion steadily growing over several years

• Suspicion of neoplasm

• Difficulty breathing

Findings from previous surgeries

• High surgical risk

• Deemed inoperable elsewhere

• Observation only was recommended

Special considerations

• Need to rule out malignancy

• Accurate histological diagnosis essential

• Importance of complete resection

• Complete resection of the mass

• Prevention of recurrence

• Surgery planned with safety in mind

Complete resection of the left-sided mass

• Precise resection of the mass obstructing the nostril

• Preservation of surrounding normal tissue

• Securing clear resection margins

Biopsy performed

• Detailed pathological examination to rule out tumor

• Pathology consultation

• Expedited histological confirmation

Foreign material removal

• Complete removal of previously inserted materials

• Removal of inflammatory source

• Establishing a clean tissue bed

Nasal tip cartilage suturing (interdomal suture)

• Securing structural stability

• Reconstruction to help prevent recurrence

• Restoring normal nasal contour

Stem cell therapy

• Promoting regeneration of damaged tissue

• Minimizing inflammatory response

• Promoting rapid recovery

Biopsy results

• Confirmed as chronic inflammatory tissue

• Confirmed negative for malignancy

• Relief for the patient and family

Before surgery / Day 0 immediately after surgery Photos taken immediately after surgery show swelling and may differ from the final result.

Successful mass resection

• Complete and clean removal

• Restoration of normal nostril shape

• Improvement of breathing function

Before surgery / Day 0 immediately after surgery Photos taken immediately after surgery show swelling and may differ from the final result.

Recurrence-free recovery

• No signs of recurrence to date

• Stable healing process

• Normal tissue regeneration

Before surgery / Day 0 immediately after surgery Photos taken immediately after surgery show swelling and may differ from the final result.

Successful outcome

• Mass resection and surgical planning

• Complete resection achieved

• High patient satisfaction

Before surgery / Day 0 immediately after surgery Photos taken immediately after surgery show swelling and may differ from the final result.

This was a particularly meaningful surgery for a patient who had been told by several clinics that surgical intervention was not possible. Because the mass obstructing her left nostril had continued to grow over several years, there was even suspicion of a neoplastic process.

The most critical step was obtaining an accurate diagnosis. Since the mass was progressively growing and malignancy could not be ruled out, complete resection was performed alongside a biopsy. Fortunately, the histological examination confirmed chronic inflammatory tissue, bringing immense relief to the patient and her family.

The resection margin was planned carefully, taking into account the location and size of the mass, as well as the tissue damage caused by repeated prior operations. An approach aimed at completely excising the mass while preserving normal intranasal tissues was evaluated and executed.

The development of chronic inflammatory tissue is presumed to stem from foreign materials used in previous operations combined with recurrent inflammatory responses. In particular, because the mass began and steadily enlarged after a dermal fat graft in 2023, a chronic inflammatory reaction to foreign materials was likely the primary underlying cause.

The core objective of the surgery was complete and clean resection. Leaving even a small portion behind carries a high risk of recurrence; therefore, the mass was thoroughly excised using precise surgical techniques. At the same time, surrounding normal tissues were preserved as much as possible to avoid functional or cosmetic deficits.

Combining stem cell therapy was another crucial decision. This was intended to facilitate the regeneration of tissue damaged by chronic inflammation, minimize postoperative inflammatory responses, and help prevent recurrence.

The most encouraging aspect is that the patient is recovering stably without any recurrence to date. The mass, which had grown continuously for several years, was fully resected, and healing is progressing normally. The nostril has also regained its normal shape, resolving her breathing difficulties.

The extent of resection and the postoperative management plan were determined after thoroughly evaluating the location of the mass and the tissue condition.

In the second surgery planned for April 2025, we plan to perform an autologous, implant-free reconstruction for cosmetic improvement. While maintaining the current stable state of recovery, we expect to achieve a natural and balanced nose.

This was Dr. Peter C. Kang. Thank you.

#closedrhinoplasty #revisionrhinoplasty #nostrilmassresection #chronicinflammatorytissue #differentialdiagnosis #stemcelltherapy #completeresection #preventionofrecurrence