Supernumerary nostril. A rare congenital nasal deformity: case report and literature review

Diprosopus: A Rare Case of Craniofacial Duplication and a Systematic Review of the Literature

In 1990, Gorlin et al. described four types of craniofacial duplications: (1) single mouth with duplication of the maxillary arch; (2) supernumerary mouth laterally placed with rudimentary segments; (3) single mouth with replication of the mandibular segments; and (4) true facial duplication, namely diprosopus. We describe a newborn born with wide-spaced eyes, a very broad nose, and two separate mouths. Workup revealed the absence of the corpus callosum and the presence of a brain midline lipoma, wide sutures, and a Chiari I malformation with cerebellar herniation. We conducted a systematic review of the literature and compared all the cases described as diprosopus. In 96% of these, the central nervous system is affected, with anencephaly being the most commonly associated abnormality. Other associated anomalies include cardiac malformations (86%), cleft palate (63%), diaphragmatic hernia (13%), and disorder of sex development (DSD) (13%). Although the facial features are those that first strike the eye, the almost obligate presence of cerebral malformations suggests a disruptive event in the cephalic pole of the forming embryo. No major monogenic contribution has been recognized today for this type of malformation.

Nasal Duplication: A Review of Literature and Case Report

INTRODUCTION

Nasal duplication is a rare congenital deformity with many subtypes including supernumerary nostril. The challenge of surgical correction is to achieve nasal symmetry and restore nasal airflow. However, there is no defined protocol for treatment, especially with regard to presurgical therapy.

METHODS

We performed a review of literature of studies reporting on patients with supernumerary nostril to complete this review. We then report on a patient with supernumerary nostril who was treated with nostril expansion therapy prior to surgical intervention.

RESULTS

We identified 59 cases of nostril duplication. Because of the rarity of the condition, treatment protocols varied greatly. For our patient, preoperative nasal appliance therapy was implemented for 3 months prior to surgical intervention. Patient was followed-up regularly for 1 year.

DISCUSSION

Although literature on nasal duplication is scarce, there is a general agreement that early intervention has psychological, anatomic, and functional benefits to the patient. In our case report, nostril expansion therapy was easy to implement and facilitated surgical reconstruction, resulting in aesthetic outcome and expanded airway 1 year postoperatively.

Isolated Congenital Supernumerary Nostril in an Adult Patient

The supernumerary nostril is a congenital accessory nostril, which is considered to be one of the rarest congenital nasal anomalies with an unknown etiology. We present the first case of a supernumerary nostril in an adult Saudi patient, which is the first such isolated case to be reported among the Middle Eastern Arab countries. An 18-year-old Saudi woman presented to the facial plastic clinic of King Fahad Medical City, Riyadh, with a complaint of an additional small left nasal opening since birth. She underwent circumferential surgical excision of the accessory nostril and its entire tract, following which the overlying skin was sutured. The patient appeared fine postoperatively with a satisfactory nasal appearance. In conclusion, patients with supernumerary nostrils should be thoroughly assessed to eliminate the presence of any other associated congenital anomalies. Early diagnosis and surgical management can facilitate a better reconstructive outcome.

Supernumerary nostril: Congenital adrenal hyperplasia with a rare congenital anomaly

Multiple or supernumerary nostril is a rare congenital anomaly with unknown etiology. The first case was reported by Lindsay as bilateral supernumerary nostrils. Supernumerary nostril cases are mostly unilateral and isolated. They are also reported with other congenital malformations like facial clefts and congenital anomalies like congenital auricular hypoplasia, congenital cataracts, eusophageal atresia and patent ductus arteriosus. Here, we report a case of supernumerary nostril with congenital adrenal hyperplasia

Partial craniofacial duplication: a review of the literature and case report

Diprosopus (Greek; di-, "two" + prosopon, "face"), or craniofacial duplication, is a rare craniofacial anomaly referring to the complete duplication of facial structures. Partial craniofacial duplication describes a broad spectrum of congenital anomalies, including duplications of the oral cavity. This paper describes a 15 month-old female with a duplicated oral cavity, mandible, and maxilla. A Tessier type 7 cleft, midline meningocele, and duplicated hypophysis were also present. The preoperative evaluation, surgical approach, postoperative results, and a review of the literature are presented. The surgical approach was designed to preserve facial nerve innervation to the reconstructed cheek and mouth. The duplicated mandible and maxilla were excised and the remaining left maxilla was bone grafted. Soft tissue repair included closure of the Tessier type VII cleft. Craniofacial duplication remains a rare entity that is more common in females. The pathophysiology remains incompletely characterized, but is postulated to be due to duplication of the notochord, as well as duplication of mandibular growth centres. While diprosopus is a severe deformity often associated with anencephaly, patients with partial duplication typically benefit from surgical treatment. Managing craniofacial duplication requires a detailed preoperative evaluation as well as a comprehensive, staged treatment plan. Long-term follow up is needed appropriately to address ongoing craniofacial deformity.

Case of supernumerary nostril

A supernumerary nostril is a very rare deformity. We encountered one case of a supernumerary nostril, but it was a type which had not been reported previously. We devised a surgical technique based on a new concept, and obtained good results. We also attempted to classify various shapes of supernumerary nostril and ways of treating them, and report our findings here.