Abstract
The bifid nose is an uncommon malformation with a wide range of clinical findings. Some authors have discussed the best time for surgery, the best surgical technique classified by severity, and the typical course of treatment, but their findings have still not been widely accepted. Because the severity of malformation can vary, it is an important key point in determining the appropriate surgical technique for reconstruction. In this report, we describe three cases that demonstrated mild, moderate and severe bifid noses and a new severity classification, with discussion of some of the literature.
Three children: a 13-year-old boy, a 6-month-old boy, and a 1-month-old girl presented with mild, moderate, and severe nasal bifidity. There were no associated craniofacial anomalies. Our assessment of the bifid noses in this series was used to establish a classification system, with the three cases classified as mild, moderate and severe. Mild cases present aberrant soft tissue and few abnormalities of the nasal cartilage, such as separation. Moderate cases present severe abnormalities of the nasal cartilage, including complete absence. Severe cases present aberrant nasal bones and severe saddle nose. In all three cases, we made a dorsal nasal skin excision to obtain a good surgical field. In all cases, the nasal cartilage was exposed and replaced under direct vision. In the mild case, bilateral separated nasal cartilages were moved medially by suturing them to each other and a dermal graft was put on the cartilages. In the moderate case, the upper lateral cartilage was found to be absent. The bilateral separated alar cartilages were moved medially by suturing each cartilage and the nasal fascia, and a dermal fat graft was added. In the severe case, a dermal fat and bone graft was inserted to modify the saddle nose.
This report describes only three cases, and thus it is important to investigate further cases in the future.
