31 Paraffinomas (Lipogranulomas)
Various materials can induce the formation of granulomas. It is known, for example, that exposure to talcum or aluminum can induce granuloma formation at various sites in the body. Mineral fats such as paraffin and petroleum jelly are of special significance in the nose. Paraffinomas have repeatedly been described after rhinoplasties and sinus operations. 1 , 2 Mineral fats are contained in ointments that are placed on postoperative intranasal packing. Paraffin, for example, may enter the subcutaneous tissue or muscle through dehiscent sites or osteotomies, inciting a granulomatous reaction with the formation of paraffinomas. 3 The latent period to paraffinoma formation is variable. The typical clinical presentation is that of a firm, slowly progressive swelling. Histology shows a foreign-body granuloma with abundant giant cells, and numerous cavities typically remain in the specimen after deparaffination. 4 Various ointments applied to wounds and muscles may incite a spherocytosis or myospherulosis. 5 Histology reveals cystic cavities of varying size surrounded by histiocytes and multinucleated giant cells. The pathogenic mechanism is similar to that of paraffinomas.
Case 49
Introduction
The patient, then 32 years of age, had undergone several nasal operations in her native country of Hungary: a septoplasty in 2003, hump removal in 2004, and another revision in 2008. The patient desired aesthetic improvement of her nasal shape and also sought treatment for multiple facial tumors that had formed since her second operation.
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