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Surgical Technique |

Midline Cleft:  Treatment of the Bifid Nose

Philip J. Miller, MD; Daniel Grinberg, MD; Tom D. Wang, MD
Arch Facial Plast Surg. 1999;1(3):200-203. doi:.
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Published online

Background  Midline facial clefts are rare deformities with a wide range of clinical findings from a simple midline vermillion notch to major skeletal malformations, including orbital hypertelorism. The bifid nose is a relatively uncommon malformation that is frequently associated with hypertelorbitism and midline clefts of the lip. The presentation of a bifid nose ranges from a minimally noticeable midline nasal tip central groove to a complete clefting of the osteocartilaginous framework, resulting in 2 complete half noses. We describe our experience with 2 patients with midface clefts who presented with bifid noses and a variety of other congenital abnormalities. The anatomy, extensive treatment, and complications of the bifid nose are discussed.

Design  Retrospective case review and literature review.

Results  Successful creation of an aesthetic nasal contour and normal nasal function was achieved without complication via extensive skin, bony, and cartilaginous resection.

Conclusions  The bifid nose challenges the rhinoplasty surgeon. A successful outcome is dependent on a thorough understanding of the bifid nasal anatomy, proper patient evaluation, careful preoperative planning, and meticulous surgical technique.

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Figure 1.

A 41-year-old man with congenital bifid nose. Preoperative anteroposterior view.

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Figure 2.

Preoperative nasal base view.

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Figure 3.

Intraoperative view showing the skin excision with direct visualization of the nasal skeleton.

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Figure 4.

L-shaped strut fashioned for the cartilaginous septum sutured into place.

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Figure 5.

Immediate postoperative picture showing the midline closure.

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Figure 6.

Anteroposterior photograph taken 6 weeks after surgery.

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Figure 7.

Nasal base view showing the final result.

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Figure 8.

Preoperative appearance of a 3-year-old boy with bifid nose, midline cleft upper lip, and pseudohypertelorism.

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Figure 9.

Wedge excision of the excess nasal bone with median and paramedian osteotomies.

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Figure 10.

Immediate postoperative anteroposterior view.

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