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J Cosmet Med 2022; 6(2): 95-98

Published online December 31, 2022

https://doi.org/10.25056/JCM.2022.6.2.95

A case of nasal septal gossypiboma removal and mucosal defect reconstruction

Seok Hyun Kim , MD, Hyo Beom Jang , MD, Da Hee Park , MD, Sue Jean Mun , MD, PhD

Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Yangsan Hospital, Yangsan, Rep. of Korea

Correspondence to :
Sue Jean Mun
E-mail: baskie23@naver.com

Received: October 10, 2022; Revised: October 26, 2022; Accepted: October 26, 2022

© Korean Society of Korean Cosmetic Surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

The term “gossypiboma” refers to a mass of the cotton matrix that is left in the body following an operation. It can remain silent postoperatively and appear several years later with a variety of symptoms or non-specific radiological findings. In addition, gossypiboma that persists in the human body for a long time can cause many complications when surgically removed. We report the case of a 33-year-old man who underwent rhinoseptoplasty and presented with nasal obstruction by a foreign body sensation. On endoscopic examination, protruding fabric material and granulation tissue were detected in the medial portion of the left nasal septum. Severe adhesion between the gossypiboma and septal mucosa resulted in a significant defect in the septal mucosa after endoscopic removal. The septum was approximated and reconstructed using a posterior-based inferior turbinate flap. The nasal obstruction completely resolved after surgery, and the septum healed at the six-month follow-up. This case emphasizes the possibility of gossypiboma when missing gauze remains in the patient after rhinoseptoplasty and a large septal perforation occurs as a consequence of gossypiboma removal. Rhinoplasty surgeons should be cautious to prevent materials being left inside the patient and efficiently follow-up on patients with nonspecific postoperative complaints.

Keywords: foreign bodies, gossypiboma, nasal septal perforation, nasal septum, reconstruction, rhinoplasty

Fig. 1.Endoscopic images of the left nasal cavity. (A) The preoperative image shows granulation tissue entangled with gauze filaments in the left nasal septum. (B) A six-month- postoperative image shows a well-healed nasal septum without septal perforation. (C) An eight-month-postoperative image shows a 2-mm septal perforation in the mid portion of septum.
  1. Srivastava KN, Agarwal A. Gossypiboma posing as a diagnostic dilemma: a case report and review of the literature. Case Rep Surg 2014;2014:713428.
    Pubmed KoreaMed CrossRef
  2. Sun HS, Chen SL, Kuo CC, Wang SC, Kao YL. Gossypiboma: retained surgical sponge. J Chin Med Assoc 2007;70:511-3.
    Pubmed CrossRef
  3. Lincourt AE, Harrell A, Cristiano J, Sechrist C, Kercher K, Heniford BT. Retained foreign bodies after surgery. J Surg Res 2007;138:170-4.
    Pubmed CrossRef
  4. Cho SW, Jin HR. Gossypiboma in the nasal septum after septorhinoplasty: a case study. J Oral Maxillofac Surg 2013;71:e42-4.
    Pubmed CrossRef
  5. Gawande AA, Studdert DM, Orav EJ, Brennan TA, Zinner MJ. Risk factors for retained instruments and sponges after surgery. N Engl J Med 2003;348:229-35.
    Pubmed CrossRef
  6. Cheng TC, Chou AS, Jeng CM, Chang PY, Lee CC. Computed tomography findings of gossypiboma. J Chin Med Assoc 2007;70:565-9.
    Pubmed CrossRef
  7. Kim KJ, Lim JY, Choi JS, Kim YM. Gossypiboma of the neck mimicking an isolated neck recurrence. Clin Exp Otorhinolaryngol 2013;6:269-71.
    Pubmed KoreaMed CrossRef
  8. Friedman M, Ibrahim H, Ramakrishnan V. Inferior turbinate flap for repair of nasal septal perforation. Laryngoscope 2003;113:1425-8.
    Pubmed CrossRef
  9. Kridel RW, Foda H, Lunde KC. Septal perforation repair with acellular human dermal allograft. Arch Otolaryngol Head Neck Surg 1998;124:73-8.
    Pubmed CrossRef
  10. Fencl JL. Guideline implementation: prevention of retained surgical items. AORN J 2016;104:37-48.
    Pubmed CrossRef

Article

Case Report

J Cosmet Med 2022; 6(2): 95-98

Published online December 31, 2022 https://doi.org/10.25056/JCM.2022.6.2.95

Copyright © Korean Society of Korean Cosmetic Surgery.

A case of nasal septal gossypiboma removal and mucosal defect reconstruction

Seok Hyun Kim , MD, Hyo Beom Jang , MD, Da Hee Park , MD, Sue Jean Mun , MD, PhD

Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Yangsan Hospital, Yangsan, Rep. of Korea

Correspondence to:Sue Jean Mun
E-mail: baskie23@naver.com

Received: October 10, 2022; Revised: October 26, 2022; Accepted: October 26, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The term “gossypiboma” refers to a mass of the cotton matrix that is left in the body following an operation. It can remain silent postoperatively and appear several years later with a variety of symptoms or non-specific radiological findings. In addition, gossypiboma that persists in the human body for a long time can cause many complications when surgically removed. We report the case of a 33-year-old man who underwent rhinoseptoplasty and presented with nasal obstruction by a foreign body sensation. On endoscopic examination, protruding fabric material and granulation tissue were detected in the medial portion of the left nasal septum. Severe adhesion between the gossypiboma and septal mucosa resulted in a significant defect in the septal mucosa after endoscopic removal. The septum was approximated and reconstructed using a posterior-based inferior turbinate flap. The nasal obstruction completely resolved after surgery, and the septum healed at the six-month follow-up. This case emphasizes the possibility of gossypiboma when missing gauze remains in the patient after rhinoseptoplasty and a large septal perforation occurs as a consequence of gossypiboma removal. Rhinoplasty surgeons should be cautious to prevent materials being left inside the patient and efficiently follow-up on patients with nonspecific postoperative complaints.

Keywords: foreign bodies, gossypiboma, nasal septal perforation, nasal septum, reconstruction, rhinoplasty

Fig 1.

Figure 1.Endoscopic images of the left nasal cavity. (A) The preoperative image shows granulation tissue entangled with gauze filaments in the left nasal septum. (B) A six-month- postoperative image shows a well-healed nasal septum without septal perforation. (C) An eight-month-postoperative image shows a 2-mm septal perforation in the mid portion of septum.
Journal of Cosmetic Medicine 2022; 6: 95-98https://doi.org/10.25056/JCM.2022.6.2.95

References

  1. Srivastava KN, Agarwal A. Gossypiboma posing as a diagnostic dilemma: a case report and review of the literature. Case Rep Surg 2014;2014:713428.
    Pubmed KoreaMed CrossRef
  2. Sun HS, Chen SL, Kuo CC, Wang SC, Kao YL. Gossypiboma: retained surgical sponge. J Chin Med Assoc 2007;70:511-3.
    Pubmed CrossRef
  3. Lincourt AE, Harrell A, Cristiano J, Sechrist C, Kercher K, Heniford BT. Retained foreign bodies after surgery. J Surg Res 2007;138:170-4.
    Pubmed CrossRef
  4. Cho SW, Jin HR. Gossypiboma in the nasal septum after septorhinoplasty: a case study. J Oral Maxillofac Surg 2013;71:e42-4.
    Pubmed CrossRef
  5. Gawande AA, Studdert DM, Orav EJ, Brennan TA, Zinner MJ. Risk factors for retained instruments and sponges after surgery. N Engl J Med 2003;348:229-35.
    Pubmed CrossRef
  6. Cheng TC, Chou AS, Jeng CM, Chang PY, Lee CC. Computed tomography findings of gossypiboma. J Chin Med Assoc 2007;70:565-9.
    Pubmed CrossRef
  7. Kim KJ, Lim JY, Choi JS, Kim YM. Gossypiboma of the neck mimicking an isolated neck recurrence. Clin Exp Otorhinolaryngol 2013;6:269-71.
    Pubmed KoreaMed CrossRef
  8. Friedman M, Ibrahim H, Ramakrishnan V. Inferior turbinate flap for repair of nasal septal perforation. Laryngoscope 2003;113:1425-8.
    Pubmed CrossRef
  9. Kridel RW, Foda H, Lunde KC. Septal perforation repair with acellular human dermal allograft. Arch Otolaryngol Head Neck Surg 1998;124:73-8.
    Pubmed CrossRef
  10. Fencl JL. Guideline implementation: prevention of retained surgical items. AORN J 2016;104:37-48.
    Pubmed CrossRef

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