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ABSTRACT
Pyogenic granuloma is a benign, vascular lesion of unknown etiology that occurs uncommonly in the nose. Trauma and hormonal
factors are considered major causes of pyogenic granuloma. Nasal packing is a very common procedure in rhinology and this
procedure might be related to the development of pyogenic granulomas. The most frequent symptoms of pyogenic granulomas
are epistaxis and nasal obstruction. This report represents the second case of pyogenic granuloma occurring at the middle turbinate in the English literature and it may have arisen secondary to postoperative nasal packing or intraoperative trauma.
KEY WORDSPyogenic granulomaMiddle turbinateEpistatxisNasal obstruction.
INTRODUCTION
Pyogenic granuloma, also known as lobular capillary
hemangioma, is a benign vascular lesion of unknown origin. The nasal cavity is a relatively rare location for pyogenic granulomas. The major causes of pyogenic granulomas have been suggested to include trauma or hormone
imbalances. Nasal packing is a common procedure for treating epistaxis or postoperative hemostasis, and four cases
of pyogenic granulomas have been reported in the English
literature as complications of nasal packing. Among the
four lesions, the inferior turbinate was the location of three
lesions and one lesion was located on the middle turbinate.1-4) We present a patient with a pyogenic granuloma,
which was located on the middle turbinate, who had pituitary tumor surgery by an endoscopic sphenoid sinus approach one year ago.
CASE REPORT
A 74-year-old female was referred to the department of
Address correspondences and reprint requests to Jae Hoon Lee,
M.D., Department of Otolaryngology, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Sinyongdong, Iksan 570-749, Korea
Tel82-63-859-1441, Fax82-63-841-6556
E-mailnose-1023@hanmail.net
Received for publication on August 27, 2008
Accepted for publication on October 2, 2008
otolaryngology with a three-month history of nasal obstruction and intermittent anterior nasal bleeding. She complained of nasal obstruction becoming progressively more
severe over a three month period. Nasal endoscopy revealed a lobulated, fragile, and reddish mass filling the right
nasal cavity (Fig. 1). Her otolaryngologic examination
was otherwise normal. She had undergone pituitary gland
tumor surgery by a right endoscopic sphenoid sinus approach at another university hospital one year ago. She denied
having any nasal symptoms and did not have nasal problems at the time of her surgery. Coronal computed tomography of paranasal sinus showed a soft tissue mass arising
from the right middle turbinate (Fig. 2). Preoperative laboratory testing was normal and surgery was performed under general anesthesia. Using a 0telescope, the mass was
removed easily using suction cautery, unipolar electrocautery, and various nasal forceps. The bleeding from the mass
was minimal. The 201515 mm mass originated from
the posterior portion of the right middle turbinate. After
the mass was removed, a right widened sphenoid sinus
ostium was visible. Pathologic examination confirmed a
pyogenic granuloma with proliferating blood vessels of
various sizes (Fig. 3). The postoperative course was uneventful and the patient had no further complaints.
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DISCUSSION
Pyogenic granuloma is commonly seen in the oral cavity,
REFERENCES
1) Bhattacharyya N, Wenokur RK, Goodman ML. Endoscopic excision
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