Proboscis Nose (Giant Rhinophyma): Challenges to Facemask Fit and Bag Ventilation

Rhinophyma is painless benign swelling due to hypertrophy of the sebaceous gland of the face and nose in particular. In a neglected case, it presented as ‘Proboscis-nose’. As it was hanging in front of nose it was compromising breathing ability of the patient during sleep. It was posing difficulty in placing normal size anstomical face-mask. We placed naso-pharyngeal airway under local anesthesia to retain nasal patency and largest size facemask (size-5) in a manner that it’s air filled cushion was kept deflated and wide mandibular arch was placed nasally to encase the swelling inside mask and then cushion was inflated to make it air tight fit on face. This helped us to get airtight fitting of the anatomical face mask and through nasopharyngeal airway allowed ventilation of the lungs during induction of general anesthesia before intubation. Rest of management and orotracheal intubation was achieved uneventful. We suggest use of nasal and oropharyngeal air way use and reverse uses of large facemask to attain bag-mask ventilation during induction of anesthesia in such cases.