only several cases have been reported in the literature and most of them concerned mucous cysts ( 1 - 3 ) .
although many theories have been suggested for the late cyst formation after rhinoplasty , migration or incorporation of mucosal tissue in the subcutaneous space during the surgical procedure has been accepted as an important mechanism ( 4 - 6 ) .
careful dissection and meticulous manipulation of tissue and implant are necessary to prevent the mucosa from being grafted with the implant material ( 4 - 6 ) .
rarely , a foreign body type cyst resulting from petroleum jelly impregnated with the packing material has been reported .
the authors report a case of dorsal nasal cyst that was presumed to have a different pathogenesis .
we describe this case with a brief review of the literature with an emphasis on its pathogenesis and treatment .
thirty years earlier at a local clinic , she had undergone augmentation rhinoplasty with a material presumed to be silicone .
she had had no complication afterwards . however , 5 yr previously , a nasal mass developed that had increased gradually .
physical examination showed a 3.52.5 cm round , soft , painless mass on the midline of nasal radix ( fig .
the nasal dorsum and the tip were firm on palpation and a small cruciate incision scar was found at the infratip lobule , which was supposed to be the entry of the augmentation material . on computed tomography ( ct )
scan , a heterogeneous cystic mass was observed at the radix and the cyst was continuous with a homogenous density at the nasal dorsum , which was first thought to be a silicone implant ( fig .
2 ) . a presurgical diagnosis of nasal radix cyst associated with previous augmentation rhinoplasty was made , and a direct , open approach was chosen to remove the cyst .
after a skin incision on the center of the cyst , it was dissected down to the nasal bone .
the cyst was connected to the dorsal mass , which were removed together in en - bloc fashion ( fig .
3a ) . for safe removal of the graft material over the tip area and effective tip - plasty ,
grossly , the removed cystic mass had a thick , fibrous wall with dirty cheesy material inside .
the cystic wall was composed of dense fibrous tissue containing dispersed , microsized amorphous foreign materials ( fig .
foreign materials were surrounded by foreign body type multinucleated giant cells and induced granulomatous reactions .
a scanning electron microscopy ( sem ) showed a fragment of foreign body ( fig .
4a ) and energy dispersive radiography spectroscopy ( edx ) showed presence of silicone ( si ) in the removed specimen ( fig .
the lesion was diagnosed as a foreign - body type cyst associated with silicone material used for the augmentation rhinoplasty .
the depressed radix , dorsum , and tip after excision of the mass were reconstructed using auricular and septal cartilages .
the redundant and thin skin of the radix was trimmed and reinforced with an underlay of the temporalis fascia .
the patient has been followed for 9 months postoperatively with a good aesthetic result and no complication ( fig .
exact pathogenesis of the cyst formation in our case is not clear because no information about the material that had been used for dorsal augmentation was available .
however , considering the gross and histological findings as well as the results from sem - edx analysis , foreign body inflammatory reaction from silicone material , most possibly a liquid type , which had been injected 30 yr ago , probably caused the cyst .
first , sem - edx analysis of the cyst revealed silicone in the cyst , which meant that a type of silicone material was used for dorsal augmentation .
second , silicone , whether it is a liquid type or implant type , was and still is the most commonly used material for augmentation rhinoplasty in korea .
third , a small , cruciate incision of the infratip lobule was too small to insert any type of hard material including silicone implant . although calcification and inflammatory cell infiltration around a silicone implant have been reported , total degradation is impossible considering the bio - characteristics of the silicone implant ( 7 , 8) .
sem - edx used for analyzing the graft material in this case adopted the principles that when the electron generated from the electron microscope collides with the object , a specific radiography characteristic to the object is released from the surface .
edx analysis clarifies the object by detecting this radiography , and this technique is widely used in material engineering and archeology . in our case , a small amount of silicone detected in the specimen led us to believe that the foreign body that caused cyst formation was a type of silicone material .
silicone implant has been used for rhinoplasty since 1950 and it still remains one of the most widely used implant materials in asian countries , including korea ( 9 - 11 ) .
injectable liquid silicone is useful in augmenting the chin , cheek , and glabella area ( 12 ) .
it is not recommended for rhinoplasty because the nasal skin is thin and the silicone frequently results in ridging or beading ( 12 ) .
serious complications such as severe edema or localized discoloration of the injected area has also been reported ( 13 ) .
only one case of nasal dorsal cyst after augmentation rhinoplasty using silicone implant has been reported in the literature but it 's pathologic findings and pathogenesis were not clarified ( 1 ) .
the mainstay of treating postrhinoplasty nasal dorsal cyst is complete resection and reconstruction . in this case ,
a direct open approach using the horizontal incision over the cyst center was used given the location and size of the cyst . to expose the tip , an open approach using separate transcolumellar incision
was chosen because a previous cruciate incision was located at the infratip lobule and it was too small to expose the nasal tip . in revision rhinoplasties due to complications of the allograft implant ,
fortunately , we could augment the depressed dorsum and radix with autogenous septal and auricular cartilages without harvesting the rib cartilage despite the large defect .
 development of a cystic mass on the nasal dorsum is a very rare complication of aesthetic rhinoplasty . 
 most reported cases are of mucous cyst and entrapment of the nasal mucosa in the subcutaneous space due to traumatic surgical technique has been suggested as a presumptive pathogenesis . 
 here , we report a case of dorsal nasal cyst that had a different pathogenesis for cyst formation . a 58-yr - old woman developed a large cystic mass on the nasal radix 30 yr after augmentation rhinoplasty with silicone material . 
 the mass was removed via a direct open approach and the pathology findings revealed a foreign body inclusion cyst associated with silicone . 
 successful nasal reconstruction was performed with autologous cartilages . 
 discussion and a brief review of the literature will be focused on the pathophysiology of and treatment options for a postrhinoplasty dorsal cyst . 