Bifid nose - a mild degree of frontonasal dysplasia. A case report

A ten-year surgical experience in patients of Tessier No.0 cleft with a bifid nose

BACKGROUND

Tessier No.0 cleft with a bifid nose is a rare malformation. Reconstruction of the nose is essential for children/adults to correct facial cosmetic defects and contribute to developing patients' mental health. The aim of the study was to present the 10-year clinical results using local flaps or expanded forehead flaps in bifid nose patients.

METHODS

A retrospective review was performed between January of 2010 and August of 2021 in our department. Sex, age at surgery, associated anomalies, and type of operation were reviewed.

RESULTS

A total of 33 patients were retained. The median duration of follow-up was 5.5 years. Fourteen patients underwent multi-stage nasal reconstruction using expanded forehead flap with costal cartilage as a framework, and 16 patients were operated with local skin flap with silicone while the other three were operated with local skin flap with costal cartilage. There were six cases (18.18%) of complications in our study. During follow-up, 28 patients (84.85%) had satisfactory outcomes, four patients (12.12%) had partially satisfactory results, and one patient (3.03%) had an unsatisfactory outcome.

CONCLUSION

Using local skin flap with silicone or costal cartilage rhinoplasty and nasal reconstruction using expanded forehead flap with costal cartilage for patients with a bifid nose of Tessier No.0 cleft showed that it was safe and effective, and had satisfying results in the long-term follow-up.

Rare Diseases of the Nose, the Paranasal Sinuses, and the Anterior Skull Base

Due to their low incidence and thus resulting limited diagnostic criteria as well as therapeutic options, rare diseases of the nose, the paranasal sinuses, and the anterior skull base are a significant challenge. The value as of which a disease has to be considered as rare amounts to a maximum of 5 patients per 10 000 people. Within these diseases, however, there are extreme differences. Some rare or orphan diseases like for example the inverted papilloma belong to regularly diagnosed and treated diseases of larger departments of oto-rhino-laryngology whereas other rare diseases and malformations have only been described in less than 100 case reports worldwide. This fact emphasizes the necessity of bundling the available experience of diagnostics and therapy. The present article gives an overview about rare diseases of the nose, the paranasal sinuses, and the anterior skull base from the field of diseases/syndromes of the olfactory system, malformations of the nose and paranasal sinuses, ventilation and functional disorders as well as benign and malignant tumors. The classification and data on diagnostic and therapeutic options were established based on the current literature.

Prenatal diagnosis of isolated frontonasal dysplasia: A case report

We report a case of mild frontonasal dysplasia, a complex and rare malformation affecting the central portion of the face, especially the eyes, nose, and forehead, which was diagnosed at 20 weeks of gestation. The diagnosis was made by two- and four-dimensional ultrasound and confirmed at autopsy after pregnancy termination. A review of the literature is presented.

Surgical Management of a Mild Case of Frontonasal Dysplasia: A Case Report and Review of Literature

Frontonasal dysplasia (FND) is a rare congenital craniofacial cleft syndrome associated with a spectrum of midline facial bone and soft-tissue malformations. When present, the physical features of FND are often obvious and classified at birth. The resultant facial deformities have the potential to negatively influence psychosocial health and quality of life. Reconstructive surgical intervention in early childhood can serve to restore facial contour and alleviate psychological stress. In this report, a case of a 14-year-old female with previously undiagnosed mild form of FND presented for reconstructive surgery evaluation and underwent several procedures including sliding advanced genioplasty, submucosal resection of the nasal turbinates, open rhinoplasty, and bilateral transnasal medial canthopexies. The patient had subsequent nasal tip recontouring for persistent supratip fullness. The patient achieved an acceptable esthetic outcome and was satisfied with her physical appearance. This case emphasizes the subtle presentation and reconstructive surgical options of a mild case of FND that was diagnosed at a later age, unlike the more severe phenotypes of the syndrome and other common craniofacial anomalies that are usually diagnosed and treated in early childhood. Multidisciplinary craniofacial care teams should be able to correctly diagnose and implement the appropriate surgical interventions in patients with milder forms of FND.

Open Rhinoplasty Using Concealing Incisions for Mild Bifid Nose With Unilateral Mini-Microform Cleft Lip

Bifid nose, an indicator of Tessier No.0, is a rare congenital malformation. Because of its rarity, few cases were reported and the optimal surgical procedure and the best time for surgery have not been widely acknowledged. In this brief report, a 9-year-old girl with mild bifid nose and unilateral mini-microform cleft lip, and its surgical management, is presented. We focused our attention on modifying the shape of the nose through open rhinoplasty without excising the surplus skin on the nasal dorsum and achieved good results.

CT and MRI of congenital nasal lesions in syndromic conditions

Congenital malformations of the nose can be associated with a variety of syndromes, including solitary median maxillary central incisor syndrome, CHARGE syndrome, Bosma syndrome, median cleft face syndrome, PHACES association, Bartsocas-Papas syndrome, Binder syndrome, duplication of the pituitary gland-plus syndrome and syndromic craniosynsotosis (e.g., Apert and Crouzon syndromes) among other craniofacial syndromes. Imaging with CT and MRI plays an important role in characterizing the nasal anomalies as well as the associated brain and cerebrovascular lesions, which can be explained by the intimate developmental relationship between the face and intracranial structures, as well as certain gene mutations. These conditions have characteristic imaging findings, which are reviewed in this article.