cBackground/rationale:

Rhinophyma is painless benign swelling due to hypertrophy of the sebaceous gland of the face and near tip of the nose. The swelling may compromise the breathing ability of the patient and the mask ventilation. The authors wish to share our experience to tackle it.

Methods: A 48 year male patient (body weight-62 kg, height 161 cm) presented accelerated increase in size of the large swelling at the tip of nose since last eight to nine months. The swelling started a pea sized and grew up gradually to cover entire nasolabial fold and was hanging in front of the nares. Results:

Our primary approach was to ensure adequate facemask ventilation. We first decongested patient’s nares with topical oxymetazoline hydrochloride (0.05%) and lignocaine (2%) jelly for topical anesthesia. A nasopharyngeal airway (7 mm) was placed in patent left-nares. The air cushion of facemask (5.0) was deflated and its wider mandibular curvature was placed nasally to totally encase the swelling inside mask. Then air cushion was re-inflated to get adequate mask seal. It provided good airtight seal for the bag mask ventilation during induction of the anaesthesia.

Discussion:

Tumor in and around the nose and upper lip will be challenging to fit in anatomical facemask for positive pressure ventilation. If untreated prolonged rosacea may present as giant painless swelling to be tackled carefully during induction of anesthesia.

Conclusion: Preplacement of naso-pharyngeal airway is recommended for the airway maintenance and to facilitate mask and bag ventilation.