Reccurent Foreign body Granuloma after Gore-texⓇ Removal in Rhinoplasty

Purpose: Infection, foreign body reaction and decreased volume of implant are common complications after augmentation rhinoplasty with $Gore-tex^{(R)}$ implant. The author experienced two cases of recurrent foreign body granuloma in the patients who underwent $Gore-tex^{(R)}$ removal because of infection after augmentation rhinoplasty. and treated them with complete removal of$Gore-tex^{(R)}$. Methods: Case 1: A 49 year-old female visited our clinic for recurrent foreign body reaction on nasal dorsum and tip area. The patient underwent augmentation rhinoplasty with $Gore-tex^{(R)}$ 3 years ago and implant was removed due to infection 9 months ago. Excision of the granuloma was performed and a piece of foreign body suspicious to be a $Gore-tex^{(R)}$ implant debris was detected under the subcutaneous pocket. The implant fragments were removed and nasalis muscle rotation flap was performed to cover the lesion. The specimen was proved to be $Gore-tex^{(R)}$ in histological study. Case 2: A 31 year-old-male with recurrent foreign body granuloma on the nasal tip area visited our clinic. 10 years ago, the patient had augmentation rhinoplasty with silicone implant and then, he underwent revisional rhinoplasty five times including nasal implant removal, which was performed 9 months ago. The authors excised the granuloma and found a small sized foreign body suspicious to be a $Gore-tex^{(R)}$ implant debris under the granuloma. The foreign body was excised and identified to be $Gore-tex^{(R)}$ in histological study. Results: In both cases, the lesions were healed without any complications and there were no evidences of recurrence up to 6 months of follow-up. Conclusion: The $Gore-tex^{(R)}$ is known to be weak against mechanical force. These properties of $Gore-tex^{(R)}$ make it difficult to remove the implant completely. In the patient who have infection after augmentation rhinoplasty with $Gore-tex^{(R)}$, the operator should take care to perform the complete removal without remaining fragment of the implant.

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