Rapid Treatment of Rhinophyma with Powered Microdebrider

We describe here our experience in using sinus microdebrider to rapidly debulk and sculpt the tissues in cases of rhinophyma correction. We utilized the use of the 4？mm M4 Rotatable Cutting Straight Sinus Blade on a straight Straightshot M4 Microdebrider by Medtronic at 800 rpm oscillation which is normally utilised in our sinus surgery practice. The microdebrider is straightforward to use and is already stocked in most ENT departments. It requires no additional training or cost outlay for departments that perform endoscopic sinus surgery with microdebrider. In our experience it affords the surgeon the ability to rapidly and accurately sculpt the nose to an excellent aesthetic result. We feel it is a more precise tool than cold steel or Bovie cautery, quicker than CO2 laser techniques, and avoids the aerosol of dermabrasion. No complications occurred in our series, and all patients rated their cosmetic outcome as good to excellent. 1. Introduction Rosacea is a common condition with classic symptoms such as intermittent patchy flushing, erythema, and inflammation. It has a predilection for the face particularly on the cheeks, nose, forehead, and around the mouth. Rosacea typically appears between the ages of 30 and 50 and affects more women than men. It runs a chronic course with a small minority of patient progressing to phymas (Greek = swelling, mass). Rhinophyma occurs almost exclusively in men. In one study of 108 patients with rosacea only 14% of patients were suffering from rhinophyma and 93% were men [1]. The tumour-like phymas progressively enlarge in size causing increasingly overt deformity. Rhinophyma may lead to social stigmatisation as there is a frequent incorrect causal association with the condition being self-inflicted by excess alcohol intake, the “Whiskey nose”, or through facial deformity in severe cases. Over time as the rhinophyma enlarges the excess weight of the phymatous tissue on the alar can lead to collapse of the internal and external nasal valves with resulting functional nasal obstruction. Surgical reduction is indicated when there is significant enlargement of the soft tissues [2]. We describe our experience using rapid sculpting of the phymatous tissues of the nose using the Straightshot M4 Microdebrider normally utilized in sinus surgery in 3 patients. 2. Technique All cases were performed under general anaesthesia. The surgical field was prepared with Betadine an aqueous solution of 10% povidone-iodine. The nose is injected with local anesthetic lignocaine 2% with 1 in 80,000 adrenaline. Initially a ring block around