A congenital accessory skin appendage of the nasal columella and nostril sill: a rare anatomical variation

Congenital Nostril Stenosis with a Horseshoe-like Shape

We report a rare case of congenital nostril stenosis because it is very interesting from the perspective of human embryo development. As we were not able to find a similar congenital case in the literature, we would like to describe it here. The patient is a 36-year-old woman who had bilateral congenital stenotic nostrils with horseshoe-like shape. Particularly, the bilateral medial crura protruded prominently. When she inhaled strongly, she could not breathe further because the action was analogous to the closure of a valve. Her elder sister had similar stenosis in the right nostril only, and parents did not have any stenotic nostrils. During the surgery, the prominent webs of the bilateral medial crura were resected, and Y-V advancement flap was inserted bilaterally to avoid restenosis. Histopathological examination revealed that the resected tissue contained cartilaginous and muscular tissue. A Koken retainer was worn throughout each entire day without washing the face or taking a bath for 3 months after surgery and was washed for keeping hygiene many times every day. After surgery, the patient can breathe well when she inhales strongly and is very satisfied with the operative results. Stenosis has not recurred 6 months after operation. Pathogenesis of this case is thought to occur at the early phase of embryo development when the medial and lateral nasal placodes form a downward-facing "horseshoe."

Accessory columellas: A case series on surgical method and short-term postoperative course

PURPOSE

Accessory columellas are rare congenital anomalies characterized by skin appendage in the columella of the nostril. Case reports are scattered, but there are few descriptions about the clinical features and surgical course.

METHOD

In this study, 3 patients with 4 lesions were identified (2013-2020). They were morphologically classified, and the accompanying nose deformity, surgical procedure, and postoperative course were examined.

RESULTS

According to the morphologic classification, 1 lesion was of the sessile-lobed type, 2 lesions were of the sessile-nodular type, and 1 lesion was of the pedunculated-ovoid type. In terms of accompanying nose deformities, 1 lesion had a wide nasal columella, and 1 lesion had an enlarged left nostril due to a depression at the base of the lesion. Simple ablations were performed in 2 of the lesions, and plastic procedures were performed in the 2 lesions with an accompanying nose deformity.

CONCLUSION

As in our cases, accessory columellas may have a variety of appearances and accompanying deformities. The surgical procedure must be considered according to the case. In addition, any changes due to growth must be observed and taken into consideration when they are reoperated.

Concurrent Excision of Dorsal Nasal Scars and Reduction Rhinoplasty: A Retrospective Cross-sectional Study

Skin lesions and traumas can affect the skin by leaving scars. The purpose of this study was evaluating the results of a new technique in reconstructive surgery of scars on the nose. In this technique, extra skin remaining from reduction rhinoplasty is applied to the defect remained from removing the scar.

Methods

This is a retrospective cross-sectional study performed on 33 patients who underwent reduction rhinoplasty from 2013 to 2018 due to scars on the dorsal nasal skin. Five sets of standards, criteria, and questionnaires were used to evaluate the cosmetic outcomes, scars, and nasal function. These included the Cakir concept, visual analogue scale, patient reported outcome measurement, Stony Brook scar evaluation scale, and sino-nasal outcome test-22.

Results

According to the surface polygon concept, or Cakir concept, the number of affected polygons due to scars decreased in all included patients (P < 0.05). In addition, constant improvement in patients' satisfaction, based on patient reported outcome measurement (P < 0.001) and visual analogue scale (P ≤ 0.05), as well as physicians' satisfaction, based on Stony Brook scar evaluation scale, were determined. Furthermore, evaluating the patients' breathing, based on sino-nasal outcome test-22 criteria (P < 0.09), indicated no adverse effects.

Conclusion

Excision of scars from dorsal nasal skin and conducting rhinoplasty surgery from the same access can be considered an option for reconstructing nasal scars.