Nasal dorsal granuloma after nasal bone fracture

A granuloma on the nasal dorsum after nasal bone fracture is a rare complication, like postrhinoplasty nasal cysts which were previously rarely reported. The authors describe five cases of nasal dorsal granuloma following nasal bone fracture reduction. Rubbery hard non-tender fixed masses were noted in the nasal root area 1 to 10 months after nasal bone reduction. The masses were managed by excision using a direct percutaneous approach. Histopathologic findings were of chronic granulomatous inflammation with infiltrations of epitheloid cells and Langerhans' giant cells and necrosis-like tuberculous tubercles. Acid-fast bacilli (AFB) stains were negative. The exact cause of this granuloma is not known, but imbedded free mucosal fragment or effused antibiotic ointment of packed gauze through the fracture site, which could cause a tissue reaction, is thought to be the cause of the granuloma. In order to prevent this rare complication, we recommend that aggressive practices and overpacking should be avoided during nasal bone reduction.