Proboscis lateralis: a case report

A Case Report on Lateral Proboscis: A Rare Congenital Anomaly

Lateral proboscis is a rare congenital condition characterized by a cylindrical protuberance on the nasofrontal region accompanied by abnormal nasal development on the affected side. We aimed to describe the management of the lateral proboscis in staged repair. A 7-year-old girl came with a tube-like projection on the left medial canthal region and nasal agenesis on the ipsilateral side. She was diagnosed with lateral proboscis, left microphthalmia, lower eye lid coloboma, and asymmetry in the orbital region. The patient has undergone 3 major surgeries at our institution. The first surgery involved the deconstruction of the tube to form the left nasal body and nostril. The second operation involved trimming of the new nose form and the excision of the bony protrusion directly beneath the base of the pedicle through bifrontal craniotomy. The remaining bone defect was closed using a pericranial flap. The orbital floor was reconstructed using titanium mesh. The third operation involved nasal reconstruction using a costal cartilage graft to create a dorsal nasal and alar framework. The patient healed with no complications, had become less reserved and her grades improved significantly after the operation. Further appointments are being scheduled to evaluate growth distortion and the resulting facial asymmetry. Surgical correction will be planned thereafter to further reconstruct the facial features. Evaluation of patient is necessary to explore possible clinical outcomes and corresponding treatment options. Multidisciplinary management is highly recommended, involving plastic surgeons, neurosurgeons, ophthalmologists, pediatricians, and pediatric psychiatrists in order to improve patient's quality of life.

Coexistence of proboscis lateralis and multiple craniofacial, neurological, cardiac and spinal deformities: a one-of-a-kind case report

BACKGROUND

Proboscis lateralis (PL) is an uncommon congenital facial deformity marked by the protrusion of a primitive tubular structure made up of skin and soft tissue that generally emerges from the eye's medial canthus and is associated with some craniofacial deformities. We report the first case of PL with multiple craniofacial, neurological, cardiac, and spinal anomalies.

CASE PRESENTATION

A full-term female baby delivered by cesarean section cried immediately at birth. The mother reported having a normal pregnancy but has a history of x-ray during her first trimester. The baby was born with a rare presentation of proboscis lateralis which was accompanied by multiple anomalies, including but not limited to bilateral colpocephaly, corpus callosum agenesis, complex cyanotic congenital heart disease, and hemivertebra of the T10 body.

CONCLUSION

PL is an uncommon congenital condition that causes a variety of craniofacial abnormalities. Multiple additional defects affecting various organ systems should also be evaluated in a person diagnosed with PL.

Ophthalmic manifestations of proboscis lateralis

Proboscis lateralis (PL) is a rare congenital malformation of the craniofacial structure with varied clinical associations. None of the studies documented a discrete review of ophthalmic presentations in PL. The principal aim of the present study is to explore the ophthalmic manifestations of PL. The ancillary goal is to derive a relationship between congenital deformity in PL and various ophthalmic anomalies. Databases were searched in order to obtain articles related to PL. A qualitative systematic analysis of 100 subjects was performed. In PL, eyelid coloboma (32.6%) is the most common ocular feature, followed by hypertelorism (25.3%), iris coloboma (22.4%), lacrimal system abnormality (20.7%), malpositioned eyebrow (14.4%) and retinochoroidal coloboma (12.9%). Sinonasal deformity is the most common systemic abnormality, detected in 87.9% of cases of PL, as compared with central nervous system involvement (56.2%) and other anomalies. The analysis showed a strong significant association between brain abnormalities and hypertelorism (p=0.000) and between brain abnormalities and micro-ophthalmia/anophthalmia (p=0.000). Statistically significant association was noted between cumulative ocular abnormalities and cumulative systemic abnormalities (p=0.001). The present study on PL reviewed the salient features of this rare congenital disorder. The study outcome provides a new aspect to concomitant ocular abnormalities. This study supports the view that other congenital anomalies in cases of PL had significant influence on certain ophthalmic anomalies.

A rare case of bilateral proboscis lateralis: Prenatal US and MRI findings

Proboscis lateralis is a very rare congenital craniofacial malformation characterized by a finger-like tubular appendage arising usually from the medial canthal region. It is mostly unilateral and associated with other craniofacial malformations. Occasionally, proboscis lateralis is seen with holoprosencephaly. A rare case of bilateral proboscis lateralis which was diagnosed prenatally by ultrasound and magnetic resonance imaging has been presented. In this case of bilateral proboscis lateralis, both lesions arose from a very lateral location and were associated with various central nervous system anomalies other than holoprosencephaly.

A rare case of proboscis lateralis with median cleft lip

A very rare case of proboscis lateralis is reported. This case is different from previously reported cases due to proboscis lateralis, single nostril, loss of columella, and median cleft lip without holoprosencephaly. In addition, this is considered the first surviving individual with proboscis lateralis accompanied by median cleft lip.

Proboscis lateralis

INTRODUCTION

Proboscis lateralis is a rare congenitally acquired facial abnormality characterized by a soft-tissue tube- or trunk-like appendage projecting from the surface of the face, most frequently rooted in the medial canthal region. Proboscis lateralis is generally associated with a wide range of concomitant craniofacial anomalies, giving rise to multiple theories describing the embryological pathogenesis and various classification systems to account for the pathological associations.

RESULTS/CONCLUSION

This paper provides a literature review of the rare manifestations of proboscis lateralis and represents a summary of current literature related to embryological pathogenesis, definitive diagnosis, and surgical management approaches.

Proboscis lateralis: case report and overview

We present a rare case of the congenital malformation of the nose in a 10-month-old baby.

New classification scheme of proboscis lateralis based on a review of 50 cases

BACKGROUND

Among congenital nasal deformities, proboscis lateralis is one of the rarest. Boo-Chai classified proboscis lateralis into four groups. Recently, we encountered a new case of proboscis lateralis with median cleft lip. We noticed that this classification had not been considered according to convalescence and embryologics, and further refinement seemed to be needed.

METHODS

We reviewed all cases of proboscis lateralis reported in English through 2009 and classified them by intercanthal distance.

RESULTS

A total of 34 studies involving 50 cases were reviewed. Six cases were identified as having normal intercanthal distance. Three of them presented nose abnormalities and fit Boo-Chai group II category. The other three were consistent with group I. Hypertelorism was observed in 27 cases and was further divided into two groups based on the occurrence of a frontal encephalocele. Seventeen cases without a frontal encephalocele were compatible with Boo-Chai groups III and IV. The other 10 cases associated with a visible encephalocele had encephalopathy; most died at an early age, and long-term survival cases suffered developmental delay and mental retardation. Seventeen cases were defined as hypotelorism, and all cases also presented as holoprosencephaly.

CONCLUSIONS

The redefined classification contains two new groups: group V as hypertelorism with encephalocele and group VI as hypotelorism. A new classification scheme is proposed as not only convenient for clinical application but also embryologically accurate.

Proboscis lateralis

An otherwise healthy 1-month-old female infant presented with a congenital nasal appendage in the left medial canthal region with associated left-sided nasal hypoplasia. The diagnosis of proboscis lateralis was made, and a 2-stage excision and reconstruction was performed in conjunction with probing and irrigation of the lacrimal system. The patient had markedly abnormal nasal anatomy, but a patent lower canalicular system with anomalous entry in the nose and a distally stenotic upper canalicular system on the affected side. A case report and review of proboscis lateralis is provided, as treatment of this rare congenital malformation should be multidisciplinary and necessitates an informed oculoplastic surgeon or ophthalmologist's assistance.

Proboscis lateralis: a rare craniofacial anomaly, reconstruction, and long-term evaluation

Proboscis lateralis is a rare spontaneous congenital anomaly that results from a failure of normal embryological nasal development. The ensuing deformity consists of imbrication of the nasal soft tissues into a tubelike proboscis and can be associated with ipsilateral heminasal aplasia, choanal atresia, and multiple other abnormalities. A case report of a patient with proboscis lateralis is presented, with a 27-year follow-up detailing the complexities of long-term surgical management. After 15 major surgical interventions, there is relatively normal facial symmetry, but abnormalities remain with the underlying craniofacial skeleton and nasopharyngeal airway. Proboscis lateralis is not an isolated soft tissue abnormality but is a craniofacial defect that requires a long-term multidisciplinary approach to the surgical timing and treatment with lifelong follow-up.

An unusual congenital facial anomaly: erectile proboscis-like structure

We report a 3-week-old male infant with an unusual congenital facial anomaly, which is characterized by a proboscis-like erectile structure arising from the right malar region. Although it is a tubular structure resembling the proboscis lateralis, this case was more likely to be a new congenital anomaly because of the following reasons: (1) in contrast with the proboscis lateralis, which originates from the medial portion of the orbital roof, the structure was located at the right malar region in our case; (2) although it was soft and freely dangling on the face, this proboscis-like structure was strongly erectile, with contraction of the orbicularis oculi muscle when the infant cried; (3) histopathological examination revealed that the structure was composed by normal fibroadipose tissue and striated muscle covered with a healthy skin and subcutaneous tissue. In contrast with histopathological characteristics of a proboscis lateralis, there was neither osteocartilaginous tissue nor mucosa in the structure. Although it is a typical finding for a proboscis lateralis, no lumen was found in the presented anomaly. Because of these unique characteristics, which remarkably differ from previously reported facial anomalies, we thought this case worth reporting. A literature review revealed that no similar case has been reported in the literature.

Proboscis lateralis: report of two cases

Proboscis lateralis is a rare congenital anomaly and heminasal aplasia is the most common associated anomaly. The proboscis is an ideal donor structure that has good colour and texture match to reconstruct the heminose and should not be sacrified. We present the staged reconstruction of two patients using a subcutaneous tunnel method. An individualised approach to the patient determines the ideal method of reconstruction.

Extramedullary hematopoiesis within a frontoethmoidal encephalocele in a newborn with holoprosencephaly

We present the first report of extramedullary hematopoiesis (EMH) in an encephalocele. The patient was a new-born with semilobar holoprosencephaly, a frontoethmoidal encephalocele, and a large subdural hematoma. The encephalocele appeared as a hemorrhagic mass, protruding from the forehead to cover the right eye, without involvement of the sinuses or nasopharynx. Computerized tomography and magnetic resonance imaging studies ruled out other forms of holoprosencephaly and confirmed the continuity of the brain with the extruded mass. Immunohistochemistry confirmed the presence of an atrophic epithelium covering the mass. Histologic examination of the encephalocele revealed EMH both within and adjacent to malformed cerebral cortex, with a tendency for the hematopoietic cells to line up in columns within malformed cerebral cortex. We propose that a single event during the fourth week of gestation could both interrupt closure of the neural tube, giving rise to the encephalocele, and impair migration of the neural crest, leading to holoprosencephaly secondary to failure of neural crest derivatives to induce basomedial telencephalic differentiation. EMH may have been induced from hematopoietic stem cells in the richly vascular meningeal component of the encephalocele, in response to anemia and hypoxia.