Incidental finding of an endonasal mass: A misleading clinical appearance with an unexpected pathological diagnosis

Introduction: Textilomas or gossypibomas consist of inflammatory lesions consequent to retained cotton-fabric surgical materials in the body. Literature mainly describes abdominal surgery cases, whereas in the head and neck region only a few reports have been published. Especially in the sinonasal compartment, endoscopic surgery and nasal packing are accountable for the etiology of these pathological entities. Case presentation: A patient with incidental radiological finding of an endonasal mass was referred to our department. The nasal endoscopy demonstrated an irregularly vascularized lesion occupying the left nasal fossa strongly suspicious for a neoplasm. Magnetic resonance imaging was performed, confirming the presence of a partially contrast-enhanced and inhomogeneous mass causing remodeling of the surrounding structures. During the biopsy under local anesthesia, cotton fibers were discovered under the outer layer of the lesion and the mass was excised and sent for histological evaluation. The pathological analysis resulted in an inflammatory lesion consequent to a retained gauze. A more cautious anamnesis revealed a history of nasal packing two years before possibly accountable for the retained sponge. Conclusion: A textiloma of the sinonasal region is a potentially serious but preventable disease and it should strongly be suspected in the differential diagnosis of patients with a history of sinonasal surgery or nasal packing. The use of bio-absorbable materials and multidisciplinary clinical care pathways should be implemented in order to prevent textilomas formation.