A Case Report of a Rare Congenital Anomaly: Supernumerary Nostril

Background: Supernumerary nostril is a rare congenital nasal deformity with 21 cases described in literature from 1906 to 2006. ¹Duplicated anomalies of the nose result from aberrant embryological development. It includes: polyrhinia (duplicated nose) and supernumerary nostril.

Methods/ Case Report: A 15 month old, Caucasian male presented to the University of Indiana Plastic Surgery clinic for evaluation of a nose deformity. Patient was a term infant with no labor complications, otherwise healthy with no associated anomalies. Pregnancy was remarkable and there is no family history of facial or nasal deformities. A nasal examination showed a patent nasal airway on the left and a small right superior nostril with a dimple inferiorly and a large mass that is skin covered blocking the entrance of the nose on the right. No deformities of nasal bone or cartilage were noticed on physical examination. Patient underwent a computed tomography that showed no choanal atresia and brain magnetic ressonance that showed synnechia of the right nare and nasal vestibule with extension to the right inferior turbinate and nasal septum with no other nasal abnormalities nor cleft lip or palate. There was no evidence of intracranial or skull deformity.

Operative technique: A combined procedure with the Otolaryngology team was performed. It started with a bilateral nasal endoscopy performed by the Otolaryngology team that showed an enlarged inferior turbinate on the left with patent choana. An inferior right nostril connecting to a patent choana and a larger superior nostril on right open to a blind pouch that extended 4 cm posteriorly were also observed. During the procedure, the left inferior turbinate was treated to improve nasal airway.

Plastic Surgery team subsequently performed a first stage nasal reconstruction with tip rhinoplasty and Z-plasty associated with a C-flap and flap for septal reconstruction based on the inferior duplicated nasal web. The nasal mucosa was completely closed. The right primary ala was rotated into an anatomical position with interval improvement of nasal anatomy.

Results: Postoperative recovery was uneventful. The nasal contour was adequate and there was no obvious residual abnormality. The nasal airway was preserved.

Conclusion: Surgery should be performed early to avoid subsequent deformities of the nasal structure and psychosocial impacts that may follow. Association with other facial deformities as facial clefts should be investigated before planning for congenital nose reconstruction. Supernumerary nostril is often a cul-de-sac deformity and can be treated as single procedure depending on the length of the malformation.

1.Franco D, Medeiros J, Faveret P, FrancoT. Supernumerary nostri: case report and review of literature. J Plast Recosntr Aesthet Surg 2008;61:442-6.

Pre-operative

MRI Brain

Post-Operative