Supernumerary Nostril Associated with Dermoid Cyst: A Rare Case Report and Review of Literature

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Figure 2. Axial CT Scan of Nose and PNS showing accessory nostril not communicating with nasal cavity

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The patient underwent surgical excision of the dermoid cyst and accessory nostril followed by reconstruction of the defect. With the patient under general anesthesia, a elliptical incision was made incorporating the margin of the accessory nasal cavity. The mucous membrane and an almost equally thick section of submucous tissue in the accessory nasal cavity were then excised. Extreme care was taken to avoid damage to the cartilaginous frame of the accessory nasal cavity and the nasal cavity on the left side. The raw roof and the raw floor of the accessory nasal cavity were sutured together to obliterate the cavity, and the skin incision was closed with 4-0 polypropylene suture material. Similarly an incision was given along the right nasofacial groove and dermoid cyst was excised. The skin incision was closed with 4-0 polypropylene suture material. The patient recovered uneventfully.

Figure 3. Removal of Dermoid cyst

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Figure 4. Removal of accessory nostril

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Histopathological examination of the excised tissues confirmed the diagnosis of accessory nostril and dermoid cyst respectively. At the 2 week follow-up examination, the patient was doing well. The functional outcome was excellent and the cosmetic result was satisfactory.

Figure 5. Healed Repaired accessory nostril

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3. Discussion

The face develops from five facial primordia appearing as prominences around the stomodeum or primitive mouth. There is a single median frontonasal prominence and paired maxillary and mandibular prominences. These prominences are produced by the neural crest cells migrating into the branchial arches during the fourth week of gestation. Facial development occurs mainly between the fourth and the eighth week. By the end of the fourth week, bilateral thickenings develop on the ventrolateral ectoderm of the frontonasal prominence, called nasal placodes.

The margins of the placodes proliferate into medial and lateral nasal prominences, resulting in the placodes lying in depressions called nasal pits. The medial nasal prominences merge together and with the maxillary and lateral nasal prominences, resulting in separation of the nasal pits from the stomodeum. The nasal pits become nasal sacs and then develop into nostrils and nasal cavities ^[4].

Supernumerary nostrils are exceedingly rare congenital anomalies of unclear etiology. In 1962, Erich reported a case of double nose. He also supported Linsday's theory of dichotomy by atavism or parallel evolution, and he further speculated that if the accessory nasal pit is located too laterally, the fusion of the lamina is not affected, which leads to the formation of a supernumerary nostril. ^[5] In 1972, Onizuka and Tai reported the case of a single accessory nostril that had developed above the nasal ala. ^[6] In 1987, Nakamura and Onizuka reported a similar case, and they hypothesized that the cause was probably a localized defect in the lateral nasal process. ^[7] In 1992, Chen and Yeong described a case of bilateral supernumerary nostrils that were situated below the normal nasal openings, and they proposed treating such anomalies by staged corrective surgery. ^[8] In 2001, Hallak et al reported a case of supernumerary nostril in which a blind cavity was present in a normally developed nose. They advocated that corrective surgery be performed at an early age to prevent any possible alar deformity. ^[9]The present case is the 32nd case of supernumerary nostril being reported. Aslanabadi et al. reviewed 31 cases of supernumerary nostril that had been reported worldwide (Table 1) ^[10].

Table 1. Cases of supernumerary nostril reported in the literature. [10]

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