Xanthogranuloma formation after endoscopic sinus surgery: A case report

Although xanthogranuloma is known to be related to trauma or mucosa, possibly developing around a periorbital or oral lesion, xanthogranuloma related to sinusitis urgery has not been reported. We present a case of xanthogranuloma formation after endoscopic sinus surgery (ESS). A 54-year-old man with pain and swelling in the right periorbital area presented to our clinic. He had had a blowout fracture treated by ESS 2 years prior. Physical examination and computed tomography revealed an ∼1-cm × 0.7-cm cystic mass on the right lower eyelid. Subciliary exploration found a fat-like mass that we completely excised. A histological examination revealed xanthogranuloma. No recurrence was observed for 1 year. If the wall between the sinuses and the orbit and the mucosa of the maxillary sinus are injured during ESS, infectious material and hematoma could develop into chronic granulomatous inflammation. In addition, a large antrostomy and/or a damaged nasolacrimal duct are risk factors for xanthogranuloma. Antibiotics can treat the disease and prevent infection. Progressive growth of the lesion and its infiltration into surrounding tissues may result in surgical resection. Because many masses are idiopathic, the development of xanthogranuloma after simple ESS or a nondisplaced blowout fracture is possible. Although xanthogranuloma progression usually is benign and without specific complications, it may be sight- or life-threatening. Antibiotics and surgical resection are the treatments of choice and the latter can be a diagnostic tool. Physicians should be aware of the possibility of granuloma formation in patients who have undergone ESS.