Open approach via the nasal dorsum with dermal graft for bifid nose

Two novel mutations within FREM1 gene in patients with bifid nose

BACKGROUND

Bifid nose is a rare congenital deformity and the etiology is unknown. The purpose of this study was to report genetic variation in family of patients with bifid nose.

METHODS

Twenty-three consecutive patients who were diagnosed with mild bifid nose were operated with z-plasty from 2009 to 2021. Three underage patients (a pair of twins and a girl) from two family lines, who came to our hospital for surgical treatment, were enrolled. Whole exome sequencing and Sanger sequencing were conducted. Z-shaped flaps were created and the cartilago alaris major were re-stitched. Photographs and CT scan before and after surgery were obtained. Clinical outcomes, complications and patients' satisfaction were evaluated and analyzed. The follow-up time ranges from 2 to 3 years (2.4 ± 1.2 years).

RESULTS

Most patients were satisfied with the outcome (96.2%). The nasal deformities were corrected successfully with z-plasty technique in one-stage. FREM1 c.870_876del and c.2 T > C were detected with Whole exome sequencing, which have not been reported before. The results of Sanger sequencing were consistent with those of Whole exome sequencing.

CONCLUSIONS

The newly detected mutations of FREM1 have a certain heritability, and are helpful to make an accurate diagnosis and provide a better understanding of bifid nose mechanism. Z-plasty technique can be an effective technical approach for correcting mild bifid nose deformity.

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.

Surgical Correction of a Bifid Nose Deformity with a Split M-Shaped Flap

Background: Bifid nose is a representative indicator of a facial cleft in patients with frontonasal dysplasia. There is no consensus on effective methods to correct bifid nose deformities due to their varied expressions and limited reports of surgical treatments. In this article, we propose using a split M-shaped flap to treat severe dorsal and alar deformities in patients with a bifid nose. Methods: From 2012 to 2021, a total of 26 bifid nose patients underwent surgical correction of their nasal deformities, which were characterized by cleft and board dorsum, alar defects, shortened nose, and shortened or absent nasal tip. These surgeries were performed with the transposition of an M-shaped split flap. Nasal length and nasolabial angle were assessed before and after surgery. Indications, outcomes, and complications were analyzed. Patient satisfaction was evaluated using a self-assessment survey. Results: Postoperative evaluation showed stable results with increased nasal length and improved nasal appearance. Complications were seen in difficulty breathing through the nose and persistent nostril deformities. The majority of patients (92.3%) were satisfied with their surgical outcome. Conclusion: Split M-shaped flap for bifid nose treatment provides improved nasal appearance with a high patient acceptance and stable postoperative results. Clinical Trial registration: chictr.org identifier ChiCTR2000039275.

Morphological Analysis of Nose in Patients of Tessier No. 0 Cleft With a Bifid Nose in China

Objective: Facial cleft involves complex malformations. No study assessed the facial deformity of Tessier No. 0 cleft with a bifid nose. Thus, we used anthropometric measurements to access the nose in patients. Methods: A total of 24 bifid nose deformities underwent surgery at our institution between 2010 and 2019. Standardized photographs were taken preoperatively and postoperatively. Landmarks were identified on these images; measurements for nasal analysis were performed and compared with the established Chinese norms. Surgical method differences were also analyzed. Results: The median follow-up time was 2.51 years. Postoperatively, there is a significant difference in comparison with preoperative in the nasal index, medial canthus and nose width index, nasolabial angle, nasofacial angle, ala length and nasal bridge length index, nasal tip protrusion and nasal width index, and nasal width and ala length index. Furthermore, the medial canthus and nose width index, and nasal width and ala length index were significantly larger in ordinary people, while ala length and nasal bridge length index and nasal tip protrusion and nasal width index were smaller. After surgery, most angles and index were standard except the nasolabial angle in the females, and ala length and nasal bridge length index in the males. Moreover, as for the group of costal cartilage transplantation, most index and angles have improved after surgery including nasolabial angle, nasofacial angle, ala length and nasal bridge length index, nasal tip protrusion and nasal width index, and nasal width and ala length index. However, only nasal tip protrusion and nasal width index, columella length and nasal tip protrusion index, and nasal width and ala length index in the silicone prosthesis group implantation has significance. Costal cartilage transplantation can also better improve ala length and nasal bridge length index than the silicone prosthesis implantation. Conclusion: Most defects can be repaired with surgery, but the outcome has a lack of evaluation. Thus, anthropometric assessment can serve as a material for nasal and reconstructive surgery.

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.

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

Frontonasal dysplasia is an unusual congenital condition with a wide phenotypic range. Because of this, only a small number of cases and their management have been reported in the literature. The ideal surgical procedures to correct mild cases of frontonasal dysplasia, and the time to perform them, are still controversial. The case of a 9-month-old girl with a mild form of this condition (a congenital bifid nose and a duplicated frenulum), and its surgical management, is presented. The surgery achieved an early improvement of the patient's appearance and she had no complications. In the future, it is probable that she will need secondary rhinoplasty to aid in the projection of the tip and refine the shape of the nose.

Repair of a bifid nose combined with a cleft of the primary palate in a 1-year-old dog

OBJECTIVE

To report surgical repair of a bifid nose combined with a cleft of the primary palate.

STUDY DESIGN

Clinical report.

ANIMALS

A 1-year-old, male castrated Springer spaniel dog.

METHODS

With the dog in sternal recumbency, an extraoral (dorsal) approach to the nose was performed, and after surgical margins were outlined, a Y-shaped skin incision was made to remove redundant tissue and expose the bifid nasal cartilages. The cartilages were opposed and sutured together and the skin closed in 2 layers. The dog was repositioned in dorsal recumbency, and the 2 maxillary first incisor teeth were extracted. After tangential incision and undermining of the cleft defect, the mucosa was sutured in 1 layer.

RESULTS

Healing was uneventful and there was an immediate return to normal function. At 2 weeks, 3 and 6 months function was excellent without further clinical signs.

CONCLUSION

Bifid nose associated with a cleft of the primary palate can be surgically corrected.