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.

Contents Vol. 32 no. 2 July– December 2017

EDITORIAL 4 Millenials in Medicine: Tradition and Disruption Lapeña JF ORIGINAL ARTICLES 6 Ehretia Microphylla (Tsaang Gubat) versus Loratadine as Treatment for Allergic Rhinitis: A Randomized Controlled Trial Umali FAC, Chua AH 11 Hungry Bone Syndrome (HBS) in Patients Operated for Primary Hyperparathyroidism (PHPT): A Six-Year Experience Padilla-Baraoidan RZM, Capuli-Isidro MJ, Cudal BIB, Embestro-Pontillas AA 17 Prevalence and Reasons for Non-Follow-Up of Newborns with “Refer” Results on Initial Hearing Screening Ong KMC, Cruz TLG, Grullo PER 22 Thyroid Gland Invasion in Laryngeal Carcinoma Vitamog MC, Castaneda SS 25 Risk Factors for Recurrent Papillary Thyroid Carcinoma Gloria JDL, Pontejos AQY, Grullo PER 30 An Initial Overview of Management and Treatment Outcomes for Head and Neck Hemangiomas Fernandez RU 34 Oral Propranolol Therapy for Benign Capillary Hemangiomas in a Series of Adult and Pediatric Patients Dimaguila GAC, Samson ES CASE REPORTS 38 Basal Cell Carcinoma, Odontogenic Cysts, Brain and Skeletal Abnormalities (Gorlin Goltz Syndrome) in a 46-Year-Old Woman Magbuhat DCD, Matsuo JMS, de la Cruz RAR 43 Unilateral Tonsilar Hypertrophy in a 4-Year-Old Girl with Focal Dermal Hypoplasia (Goltz Syndrome) Ong JEL, Barrientos CMAG, Cruz ETS 47 Late-onset Anterolateral Thigh Free Flap Failure in Buccal Carcinoma Reconstruction Mendoza DJC, Nieves CS, Castañeda SS 51 Supernumerary Nostril in a 15-Year-Old Girl Lluisma ACP FEATURED GRAND ROUNDS 55 A Second Branchial Cleft Cyst Presenting as a Dumbbell-Shaped Anterior Neck Mass Sunga ABG, Castañeda SS FROM THE VIEWBOX 58 Unilateral Horizontal Semicircular Canal Malformation Causing Recurrent Vertigo Yang NW UNDER THE MICROSCOPE 60 Sinonasal Tract Meningioma Rivera JP, Carnate JM LETTER TO THE EDITOR 62 Total Thyroidectomy From a Patient’s Perspective Villafuerte CV PASSAGES 65 Joseph Anthony R. Rivera, MD (1980-2016) Gelera JE

Supernumerary Nostril in a 15-Year-Old Girl

Objective: To describe a rare case of a supernumerary nostril and its management, and to discuss the different theories pertaining to this type of deformity. Methods: Design: Case Report Setting: Tertiary Government Hospital Patient: One Results: A 15-year-old girl was born with one extra nasal opening. Nasal endoscopy after 15 years revealed a mucosa-lined cavity that ended blindly. Computed tomography scan showed a small opening lateral to the right nasal ala which did not communicate with the right nasal cavity. A crescent incision was made along the inner circumference of the supernumerary nostril and the blind ending nasal tract was excised. A portion of the ala was removed and a Z-plasty repair was performed. Conclusion: Treatment has to be tailored as to the presentation of a supernumerary nostril and any other associated deformity. Though various surgical interventions exist, the goal of repair is to create a functioning and normal-appearing nose. Keywords: Supernumerary Nostril, Accessory Nostril