A surgical approach to the bifid nose

Summary

A bifid nose is a rare congenital deformity due to failure of the paired nasal processes to fuse to a single midline organ during early gestation.

Mild forms can be dealt with along the principles of corrective rhinoplasty.

In the correction of moderate to severe forms of a bifid nose a new approach is presented.

Through an external skin incision an extramucous resection of a scaphoid segment of cartilage and bone consisting of the 2 widely spread laminae of the cartilaginous and osseous septum bifidum is performed and a monolaminar septum is reconstructed fusing the two septal portions together with the mucosal lining with mattress sutures in the midline. Narrowing of the wide nasal base is achieved by lateral and transverse osteotomy with consequent medial shift of the side walls.

The scaphoid shaped segment is then replanted to form the new natural hyphen looking triangular and elevated nasal roof. The alar cartilages are united in the midline and shaped to form a single tip.

In one patient with a bifid nose associated with a congenital median nasal dermoid cyst the sinus tract and the cyst were extirpated and the nose reconstructed simultaneously using this technique.