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Abstract
A literature review reveals that gout has been described as affecting many sites in the head and neck region, both in the arthritic and tophaceous form. Gout can often mimic malignancy or infection, and has been described as causing acute airway problems requiring emergency tracheotomy. Here we describe the first published case of tophaceous gout affecting the soft tissues overlying the nasal bones. The patient presented with a bony, hard, dorsal hump and requested aesthetic rhinoplasty.
We also describe an endoscopic technique for removal of tophi using a powered microdebrider system with a protected burr head. Endoscopic powered microdebrider blade excision of tophi affecting the limbs has already been described, with reduced complications when compared with conventional curettage and debridement techniques. This is the first such application to the nose.
Key words: Gout; Nasal Surgery; Endoscopic
Introduction
Gout is an abnormality of uric acid metabolism as a consequence of an overproduction or, most commonly, under-excretion of purines. The resulting hyperuricaemia leads to deposition of monosodium urate crystals in the joints and soft tissues, causing arthritis and tophi. Neutrophils ingest the crystals and initiate an inflammatory reaction, causing recurrent intermittent attacks of gouty arthritis; followed by the development of tophaceous gout as a result of a longterm failure to control high urate levels.1
Gout has a prevalence of 9.5 per 1000 women and 16.4 per 1000 men in England.2 Reported risk factors include age, alcohol consumption, hypertension, renal impairment, obesity, diuretics and a positive family history.3
The disease most commonly affects the first metatarsophalangeal joint. However, there have been diverse manifestations described in the head and neck region4 including involvement of the cricoarytenoid, sternoclavicular and temporomandibular joints.1 Tophaceous gout commonly affects the outer helix of the pinna,5 but has also been reported as affecting the arytenoid cartilages,6 thyroid cartilage,7 vocal folds,8,9hyoid bone10 and tongue.11
The diagnosis of gout is made by the identification of monosodium urate crystals in either synovial fluid or in...