Bifid nose

Medical condition

Bifid nose

Other names| Bifid nose tip, cleft nose, cleft nose tip, median fissure of nose, median cleft of nose
Actor Park Bo-gum has a noticeable bifid nose tip
Specialty| Medical genetics, plastic surgery
Symptoms| Having a cleft between the two nostrils of the nose
Complications| Usually, there aren't any.
Usual onset| Conception
Duration| Life-long (unless cosmetic surgery is done)
Causes| Genetics
Risk factors| Having parents or close relatives with the disorder
Diagnostic method| Physical evaluation
Prevention| None
Treatment| Usually, none is necessary
Prognosis| Good
Frequency| Uncommon
Deaths| None

A bifid nose (also known as cleft nose) is an uncommon congenital malformation which is characterized by the presence of a cleft between the two nostrils of the nose.[1] It is the result of a disturbance during embryological nose development.[2]

It is part of the Tessier classification for craniofacial clefts.[3]

## Signs and symptoms

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The visibility of this malformation varies from person to person; from a barely noticeable "line" in the middle of the nose to the complete clefting of the nose which results in two "half noses", the airway is usually adequate.[4][5] Individuals with this birth anomaly don't have any symptoms related to their bifid nose.

## Complications

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This condition is merely cosmetic, and the severity of it doesn't affect a person with the disorder (health-wise) since usually there is a normal and adequate nasal airway.

## Diagnosis

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This condition can be diagnosed by physical examination.

This difference can serve as a diagnostic method since it occurs alongside other malformations, such as frontonasal dysplasia, hypertelorbitism and cleft lips.[6][7]

Bifid noses can also be diagnosed prenatally via a coronal view of the face under ultrasonography, they typically have a broad appearance with "a cleavage between the nostrils resembling a double barrel gun".[8]

## Causes

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This condition is caused due to incomplete fusion of both sides of the nose during embryonic life.[9][10][11]

This anomaly is highly hereditary: autosomal dominant and autosomal recessive inheritance patterns have been observed in multiple families.[12]

If the bifid nose is accompanied by abnormalities of the anorectal and renal systems, it may be part of a different separate genetic disorder (which is characterized by overlapping toes, renal adysplasia and variable anorectal anomalies[13][14]) that is caused by autosomal recessive mutations in the FREM1 gene.[15]

## Treatment

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Generally, sutures and rhinoplasty can be done in order to get rid of a bifid nose tip (though what surgery should be done depends on the severity of the cleft nose).[16][17] Open W-shaped surgical incisions have also proven to be effective.[18] Surgery is usually done before the age of 5.[19]

## Prevalence

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This birth anomaly affects less than 0.0008% of people worldwide, making it the most common midline craniofacial cleft.[20]

8% of people with bifid nose also have hypertelorism.[21]

## Bifid nose as a hereditary trait

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Two forms of inheritance pattern for bifid noses have been described: autosomal recessive and autosomal dominant.

One case per inheritance pattern follows:

* Autosomal dominant: Anyane-Yeboa et al. (1984) describes 5 women from a 3-generation American family. Karyotypes and skull X-rays done on the younger sisters gave normal results.[22]
* Autosomal recessive: Boo-Chai et al. (1965) describes 3 siblings from a continental Indian family.[23]

## History

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This condition was first described in medical literature in 1939[24] by Esser et al. when they described 5 children (4 siblings and a male first-cousin of theirs) from a single family.[25]

## Occurrence in animals

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This condition can also occur in animals, such as dogs.[26]

## See also

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* Cleft palate
* Cleft lip
* Cleft chin

## References

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1. ^ "Bifid Nose". DoveMed. Retrieved 2022-08-25.
2. ^ Lugo-Machado, Juan Antonio; Quintero-Bauman, Alejandra; Barragán-Márquez, Fernanda; Vargas-Cárdenas, Luis Gerardo; Sepúlveda-Martínez, Mario; Jiménez-Rodríguez, Martha; Yocupicio-Hernández, Dalia; Gutiérrez-Pérez, Martha Lucia (2021-01-01). "Nariz bífida: Presentación de caso Translated title: Bifid Nose: Case presentation". Revista del Cuerpo Médico Hospital Nacional Almanzor Aguinaga Asenjo. doi:10.35434/rcmhnaaa.2021.141.885. S2CID 236398187.
3. ^ Chauhan, Dinesh Singh; Guruprasad, Yadavalli (2014-01-01). "A rare occurrence of Tessier's 0 cleft in siblings". Medical Journal of Dr. D.Y. Patil University. 7 (1): 104. doi:10.4103/0975-2870.122808. ISSN 0975-2870.
4. ^ "SNOMED CT - Bifid nose - Classes | NCBO BioPortal". bioportal.bioontology.org. Retrieved 2022-08-25.
5. ^ Miller, Philip J.; Grinberg, Daniel; Wang, Tom D. (1999-07-01). "Midline Cleft". Archives of Facial Plastic Surgery. 1 (3): 200–203\. doi:10.1001/archfaci.1.3.200. ISSN 1521-2491. PMID 10937104.
6. ^ "Bifid nose".
7. ^ "Bifid nose - About the Disease - Genetic and Rare Diseases Information Center". rarediseases.info.nih.gov. Retrieved 2022-05-10.
8. ^ Padmanabhan, Laxmi Devi; Hamza, V. Zareena; Thampi, Venugopalan Madhavan; Govindankuttymenon, Usha Madathiparambil (2014-12-01). "Double Barrel Sign: A Pointer for Prenatal Detection of Bifid Nose". Journal of Fetal Medicine. 1 (4): 187–188\. doi:10.1007/s40556-015-0032-4. ISSN 2348-8859. S2CID 72797381.
9. ^ "Bifid nose".
10. ^ Mühlbauer, Wolfgang D. (1976-09-01). "A surgical approach to the bifid nose". Chirurgia Plastica. 3 (3): 175–183\. doi:10.1007/BF00274291. ISSN 1435-0130. S2CID 37372814.
11. ^ WEAVER, D. F.; BELLINGER, D. H. (1946-10-01). "Bifid Nose Associated with Midline Cleft of the Upper Lip". Archives of Otolaryngology. 44 (4): 480–482\. doi:10.1001/archotol.1946.00680060501012. ISSN 0276-0673. PMID 21002094.
12. ^ "Orphanet: Bifid nose".
13. ^ "KEGG DISEASE: Bifid nose with or without anorectal and renal anomalies". www.genome.jp. Retrieved 2022-08-25.
14. ^ "Entry - #608980 - BIFID NOSE WITH OR WITHOUT ANORECTAL AND RENAL ANOMALIES; BNAR - OMIM". omim.org. Retrieved 2022-08-25.
15. ^ Alazami, Anas M.; Shaheen, Ranad; Alzahrani, Fatema; Snape, Katie; Saggar, Anand; Brinkmann, Bernd; Bavi, Prashant; Al-Gazali, Lihadh I.; Alkuraya, Fowzan S. (2009-11-13). "FREM1 Mutations Cause Bifid Nose, Renal Agenesis, and Anorectal Malformations Syndrome". The American Journal of Human Genetics. 85 (5): 414–418\. doi:10.1016/j.ajhg.2009.10.008. ISSN 0002-9297. PMC 2771533. PMID 19732862.
16. ^ "What is a bifid nasal tip ?".
17. ^ Tawfik, Ali; El-Sisi, Hossam Elsayed; Abd El-fattah, Ahmed Musaad (2016-07-01). "Surgical correction of bifid nose". International Journal of Pediatric Otorhinolaryngology. 86: 72–76\. doi:10.1016/j.ijporl.2016.04.004. ISSN 0165-5876. PMID 27260584.
18. ^ Wei, Jiao; Herrler, Tanja; Yu, Baofu; Chen, Xiaoxue; Dai, Chuanchang (2022-06-23). "Correction of severe bifid nose deformity using an open W-shaped incision". Journal of Plastic, Reconstructive & Aesthetic Surgery. 75 (9): 3457–3461\. doi:10.1016/j.bjps.2022.06.060. ISSN 1748-6815. PMID 35941033. S2CID 249998871.
19. ^ "Cleft Nasal Deformity". www.rchsd.org. Retrieved 2022-08-25.
20. ^ Wang, Xin; Wang, Huan; You, Jianjun; Zheng, Ruobing; Xu, Yihao; Zhang, Xulong; Guo, Junsheng; Fan, Fei (2021). "Morphological Analysis of Nose in Patients of Tessier No. 0 Cleft with a Bifid Nose in China". Frontiers in Pediatrics. 9: 768176. doi:10.3389/fped.2021.768176. PMC 8668193. PMID 34912760.
21. ^ "Symptoms: What are the signs and symptoms of autosomal recessive bifid nose? | ThinkGenetic". thinkgenetic.com. Retrieved 2022-08-25.
22. ^ Anyane-Yeboa, K.; Raifman, M. A.; Berant, M.; Frogel, M. P.; Travers, H. (1984-03-01). "Dominant inheritance of bifid nose". American Journal of Medical Genetics. 17 (3): 561–563\. doi:10.1002/ajmg.1320170303. ISSN 0148-7299. PMID 6711607.
23. ^ Boo-Chai, K. (1965-12-01). "The bifid nose. With a report of 3 cases in siblings". Plastic and Reconstructive Surgery. 36 (6): 626–628\. doi:10.1097/00006534-196512000-00007. ISSN 0032-1052. PMID 5845694.
24. ^ Lugo-Machado, Juan Antonio (2021). "Bifid Nose: Case presentation".
25. ^ "Entry - 210400 - BIFID NOSE, AUTOSOMAL RECESSIVE - OMIM". omim.org. Retrieved 2022-08-25.
26. ^ Arzi, B.; Verstraete, F. (2011). "Repair of a bifid nose combined with a cleft of the primary palate in a 1-year-old dog". Veterinary Surgery. 40 (7): 865–869\. doi:10.1111/j.1532-950X.2011.00880.x. PMID 22380669. S2CID 3377802.