Latest Rhinophyma Treatment: Microdebrider + Floseal

Written by on July 5, 2006 in Rhinophyma with 4 Comments

New surgical adjuncts in the treatment of rhinophyma: the microdebrider and FloSeal. Short Communication. The Journal of Laryngology & Otology. 2003 Jul;117(7):551-2. Kaushik V, Tahery J, Malik TH, Jones PH. Department of Otolaryngology – Head and Neck Surgery, South Manchester University Hospitals NHS Trust, Manchester, UK

The paper’s author was kind enough to supply a copy of the paper. Email me if you’d like to read it.

Abstract: Rhinophyma is considered to be the final stage of rosacea and has an unknown aetiology. We present two new surgical adjuncts for the treatment of this condition. The microdebrider is easy to use and allows precise contouring of the nose. It shares the same underlying principle as free-hand scalpel shaving but outperforms this method in key areas. We also describe a novel use for FloSeal® , a gelatin-thrombin co-mixture, utilizing its haemostatic properties to address bleeding from the re-shaped denuded nose.Our experience with the surgical treatment of rhinophyma is based mainly on the use of free-hand scalpel shaving. Drawbacks of this method include its limited abilty to perform predictable debridement and precise contouring. In contract microdebriders have proved successful in sinonasal surgery by virtue of the fact that they enable precise control of the amount and location of tissue that needs to be removed. This led us to believe that the microdebrider could play a useful role in surgery for rhinophyma.

Most surgical modalities used to treat rhinophyma are associated with significant surface bleeding. We attempted to combat this by using a haemostatic agent called FloSeal.

Surgical Technique: The procedure was conducted under a general anasthetic. A standard microdebrider was used. The shaving end of the instrument was stabilized by resting the distal shaft on the free index finger, thus enabling precise sculpting to take place.

Once a satisfactory shape to the nose had been achieved, FloSeal matric haemostatic sealant was applied. This was covered in a wet swab and light pressue applied for two minutes to prevent the substance being washed away by the bleeding surface. At the end of the procedure excess FlowSeal sealant was removed with normal saline irrigation. This achieved complete haemostasis. No dressins were required. At six week followup the result was good. This is the second occasion we have successfully used FloSeal for haemostatis in rhinophyma.

Discussion: Rhinophyma is characterized by a slow progressive over growth of the soft tissue of the nose. It can be very disfiguring and cause considerable psychosocial disability. Severe cosmetic deformity or nasal obstruction are indications for surgical treatment.

The microdebrider is a powered rotary shaving device. It has been applied usccessfully to various aspects of sinonasal surgery such as nasal polypectomy, functional endoscopic sinus surgery, turbinate reduction surgery, and septal surgery. However there appears to be only one report in the literature describing the application of this device to the nasal dorsum. Krouse successfully used a microdebrider to sculpt the bony nasal dorsum under endoscopic guidance.

In the case described, the microdebrider was easy to use and overcame some of the difficulties that can be encountered during free-hand shaving.

Floseal (Fusion Medical Technologies Inc, Mountan View, CA) is a gelatin-thrombin co-mixture and has been using in a variety of clinical settings, notably cardiac curgery where it has been demonstrated to be superior in its efficacy to that of gelfoam-thromin when used as a topical haemostatic agent. Following application to a bleeding area, blood perfuses therough the aggregate of thrombin coated gelatin granules, which expand to form a mechanical haemostatic plug. Where there is no contact with blood, coagulation does not occur. This excess rinses free with irrigation, leaving a coating of `sealant’ over the wound. Haemostasis was achieved immediately following the application of FloSeal in our cases.

To our knowledge this is the first reported use of a microdebrider and FloSeal as adjuncts in the surgical treatment of rhinophyma. The microdebrider appeared to provide satisfactory results, and overcame some of the disadvantages associated with free-hand scalpel shaving. We advocate FloSeal because of its significant haemostatic properties and ease of use. Further studies, including long-term follow-up, are required in order to ensure the safety and applicability of these techniques.

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About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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4 Reader Comments

  1. jena says:

    my brother has this kind of illness,rhinophyma,what would be the cheapest treatment for this?thank you..

  2. Hi Jena,

    I can’t say that I know of any treatments for rhinophyma that could be called cheap.

    I have summarised some suggestions here How to cure a red swollen nose but sadly I wouldn’t call any of them cheap.

    All the best,

  3. sherry poer says:

    I am looking for a dermatologist that has experience in treating rhinophyma. I have the swelling and two bumps at tip of my nose. I have seen one dermatologist that did diagnose rosacea but offered no information about the thickening of my nose and afore-mentioned symptoms. I live in central Indiana-not too far from Indianapolis. New Castle is where I am and I am centrally located to Indianapolis, Muncie, Carmel, Richmond and a few other larger cities. I would also travel farther to see an experience d doctor. The bumps are becoming larger and I want to prevent this from getting worse. I look forward to any info/assistance. Thank you.

  4. Frank says:

    With rhinophyma exceptional results can be found using Carbon Dioxide laser ablation.
    I offer this treatment and have many happy patients

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