Isolated Congenital Nasal Bifid Septum Separated by a Wide Layer of Soft Tissue

Congenital nasal anomalies are rare, with an incidence of 1%–4%. These anomalies range from simple pathology, such as septal deviation or asymmetry of the nostrils, to severe problems accompanied by different craniofacial anomalies [1]. Here, we report the case of a 19-year-old boy with an aesthetic problem of the nose. His physical examination revealed a depression on the supratip area of his nose. During open rhinoplasty, the cause of this depression was found to be congenital bifid septum separated by a wide layer of soft tissue. We have reported this interesting case because the condition had not been diagnosed until the age of 19 years, and even then, it was diagnosed incidentally during surgery. Further, we applied specific junctional surgery to this nasal bifid septum. A 19-year-old male patient underwent an aesthetic operation on his nose due to a cosmetic problem. He had no complaints of any other systemic disease or malformation. His physical examination revealed a wide depression in the supratip area of his nose and a small fistula in the middle of his columella (Fig. 1). The patient underwent open rhinoplasty. A columellar incision was made in accordance with the fistula line. Upon exploration, we observed that the fistula was a blind fistula ending at the base of the septum. The fıstula was completely excised between the lower cartilages, and both the lower lateral cartilages were explored. During surgical exploration, the nasal septum was found to be a single unit along 1/4 of the posterior segment, while it was divided by a wide layer of fibroadipose soft tissue along 3/4 of the anterior segment (Fig. 2). We removed the intervening fibroadipose soft tissue, corrected both anterior septal deviations, and joined the anterior double septum to the midline with a 4/0 monofilament synthetic absorbable suture to ensure the continuation of the posterior single septum (junctional surgery) (Fig. 3). The other parts of the nose were normal. Later, routine rhinoplasty steps were performed. The lower lateral cartilages were shaped with sutures. No osteotomy was done. After closing the nasal skin, bilateral alar wedge excision was performed. The silicone nose pads were removed on the seventh day, and no complications were observed postoperatively (Fig. 4). External nose formation begins in the fourth and fifth weeks of gestation; at this time, five identifiable primordial structures including the frontonasal prominence and the right and the left maxillary prominences are identifiable. The frontonasal prominence is responsible for nasal development during the third to tenth weeks of gestation. On the lateral aspects of the frontal prominence, neural crest cells proliferate and form the nasal placodes. The nasal placodes invaginate to form the olfactory pit, which further invaginates to form the nasal processes. Forming on the outer edge of the pits are the lateral nasal processes. Those on the inner side are the medial nasal processes. The lateral rounded angles of the medial prominence are the globular processes. These processes continue posteriorly as plates called Im ag es