Interdomal-columellar myolipoma: discovered at rhinoplasty

Overview

Fatty tumors in the nose are extremely rare. This report describes the first myolipoma, a benign tumor of fat and smooth muscle, found at the nasal tip. It was discovered only after the skin was lifted, and it explained the widened tip the patient had presented with.

Sections of note

• Single case report; level of evidence V.
• Found during open rhinoplasty after elevating the columellar flap and approaching the tip.
• Mass 2 by 1 cm, in the interdomal space and continuing between the middle and medial crura of the alar cartilages, which were displaced outward.
• Removed by sharp and blunt dissection.
• Histopathology: myolipoma.
• Described as the first nasal tip-columellar myolipoma in the literature; the unexpected finding forced a rapid change of surgical plan.
• The abstract gives no follow-up or cosmetic result.

What it means for a patient

• A wide or asymmetric tip can, very rarely, be caused by a benign growth between the cartilages rather than by the cartilages themselves.
• Surgeons may find things during rhinoplasty that imaging and examination missed, and must adapt.
• One case; no rate can be given and the final result is not reported.

Why this paper matters

It adds a new entity to the short list of masses that can be found at the nasal tip and illustrates why the operative plan must stay flexible. It has no bearing on routine rhinoplasty planning beyond that.

Terms

• Myolipoma: a benign tumor made of fat and smooth muscle cells.
• Interdomal space: the gap between the two domes, the highest points of the tip cartilages.
• Alar cartilages: the paired tip cartilages that shape the tip and nostrils.
• Medial and middle crura: the inner and intermediate segments of the tip cartilages, between the columella and the nostril.
• Columellar flap: the skin of the columella lifted during open rhinoplasty.
• Histopathologic examination: study of removed tissue under a microscope to make a diagnosis.