Arrhinia

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Arrhinia
Other namesNasal agenesis
Arhinia.jpg
Neonate with partial arrhinia.
Pronunciation
Specialty Medical genetics   OOjs UI icon edit-ltr-progressive.svg

Arrhinia (alternatively spelled "arhinia") is the congenital partial or complete absence of the nose at birth. It is an extremely rare condition, with few reported cases in the history of modern medicine. [1] It is generally classified as a craniofacial abnormality.

Contents

The cause of arrhinia is not known. [1] [2] One study of the literature found that all cases had presented a normal antenatal history. [2]

Conditions

Infant with full arrhinia in cyclopia Roland Cyclopie 2.jpg
Infant with full arrhinia in cyclopia

Arrhinia is associated with the following conditions and syndromes: [3]

History

The term "arrhinia" is derived from the Greek roots "a-" (absence) and "rhinos" (nose); it is alternatively spelled "arhinia."

The phenomenon of congenital arrhinia, which refers to the complete absence of the nose from birth, was initially documented in French literature during the 1800s. Over time, a few additional cases of individuals born with congenital arrhinia, some with accompanying eye defects and others without, were reported in medical literature from the early to mid-1900s. [4]

Dr. James Bosma, a pediatrician and researcher associated with the National Institute of Dental Health, made a significant observation while studying these patients. He noted that individuals with congenital arrhinia often exhibited problems related to genital and reproductive hormones. In his comprehensive report in 1981, Dr. Bosma described two unrelated males initially reported by plastic surgeon Dr. George Gifford et al. in 1972. These patients presented with congenital arrhinia, eye defects, and genital abnormalities, such as a small penis and undescended testes at birth, with no spontaneous sexual maturation. [4]

It is noteworthy that nearly every individual with congenital arrhinia appears to be the first and only one affected within their respective families. Nonetheless, there have been a few reports of multiple cases within the same family, with one of the earliest examples being described by Klaus Ruprecht and Frank Majewski in 1978. They reported on two German sisters who exhibited congenital arrhinia along with eye defects. [4]

Treatment

Treatment focuses on identifying the nature of the anomalies through various imaging methods, including MRI and CAT scan, and surgical correction to the extent possible. [2]

In severe cases, temporary airway devices, such as tracheostomy tubes, may be utilized to facilitate breathing until surgical intervention is deemed appropriate. [5]

Surgical procedures should only be carried out by a team of medical experts, including otolaryngologists, plastic surgeons, and prosthodontists. The arrhinia reconstruction process primarily involves two main parts: the reconstruction of the nasal cavity and the reconstruction of the external nose. [5]

There are two methods for reconstructing the nasal cavity. In the first method, two separate nasal cavities are created using a dental drill, and then silicone tubes are used to keep the newly formed nasal passages open. The second method involves a Le Fort II maxillary osteotomy, which involves making an incision through the maxillozygomatic consoles and towards the medial end of the inferior orbital rim. A horizontal arm connects the two sides, and then the maxilla is carefully fractured, creating a wide median nasal cavity that extends to the upper portion of the rhinopharynx. If the maxillary height is sufficient, the patient may only need a Le-Fort II osteotomy. However, if it is not high enough, the patient will require a Le-Fort II osteotomy first, followed by an extension along the maxillary bone. External distraction devices may also be used to provide additional facial height and sufficient midfacial vertical length for nasal reconstruction. Lengthening the maxilla has two advantages: it provides enough height for nasal cavity reconstruction and achieves suitable aesthetic proportions. [5]

Surgical treatment methods for arrhinia can involve either staged reconstruction or simultaneous reconstruction of the nasal passage and the external nose. Staged reconstruction, where the procedures are performed in separate stages, is more commonly reported than simultaneous reconstruction. [5]

Related Research Articles

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A cleft lip contains an opening in the upper lip that may extend into the nose. The opening may be on one side, both sides, or in the middle. A cleft palate occurs when the palate contains an opening into the nose. The term orofacial cleft refers to either condition or to both occurring together. These disorders can result in feeding problems, speech problems, hearing problems, and frequent ear infections. Less than half the time the condition is associated with other disorders.

<span class="mw-page-title-main">Rhinoplasty</span> Surgical procedure to enhance or reconstruct a human nose

Rhinoplasty, commonly called nose job, medically called nasal reconstruction is a plastic surgery procedure for altering and reconstructing the nose. There are two types of plastic surgery used – reconstructive surgery that restores the form and functions of the nose and cosmetic surgery that changes the appearance of the nose. Reconstructive surgery seeks to resolve nasal injuries caused by various traumas including blunt, and penetrating trauma and trauma caused by blast injury. Reconstructive surgery can also treat birth defects, breathing problems, and failed primary rhinoplasties. Rhinoplasty may remove a bump, narrow nostril width, change the angle between the nose and the mouth, or address injuries, birth defects, or other problems that affect breathing, such as a deviated nasal septum or a sinus condition. Surgery only on the septum is called a septoplasty.

<span class="mw-page-title-main">Nasal septum deviation</span> Disorder of the nose

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<span class="mw-page-title-main">Orthognathic surgery</span> Surgery of the jaw

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<span class="mw-page-title-main">Maxillary sinus</span> Largest of the paranasal sinuses, and drains into the middle meatus of the nose

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<span class="mw-page-title-main">Microtia</span> Medical condition

Microtia is a congenital deformity where the auricle is underdeveloped. A completely undeveloped pinna is referred to as anotia. Because microtia and anotia have the same origin, it can be referred to as microtia-anotia. Microtia can be unilateral or bilateral. Microtia occurs in 1 out of about 8,000–10,000 births. In unilateral microtia, the right ear is most commonly affected. It may occur as a complication of taking Accutane (isotretinoin) during pregnancy.

<span class="mw-page-title-main">Hypertelorism</span> Abnormally increased distance between two body parts, usually the eyes

Hypertelorism is an abnormally increased distance between two organs or bodily parts, usually referring to an increased distance between the orbits (eyes), or orbital hypertelorism. In this condition the distance between the inner eye corners as well as the distance between the pupils is greater than normal. Hypertelorism should not be confused with telecanthus, in which the distance between the inner eye corners is increased but the distances between the outer eye corners and the pupils remain unchanged.

Silent sinus syndrome is a spontaneous, asymptomatic collapse of an air sinus associated with negative sinus pressures. It can cause painless facial asymmetry, diplopia and enophthalmos. Diagnosis is suspected based on symptoms, and can be confirmed using a CT scan. Treatment is surgical involving making an outlet for mucous drainage from the obstructed sinus, and, in some cases, paired with reconstruction of the orbital floor. It is slightly more common in middle age.

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<span class="mw-page-title-main">Jaw abnormality</span> Medical condition

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References

  1. 1 2 Albernaz, Vanessa; Mauricio Castillo; Suresh K. Mukherji; Ismail H. Ihmeidan (30 October 2005). "Congenital Arrhinia" (PDF). American Journal of Neuroradiology. 17 (7): 1312–1314. PMC   8338532 . PMID   8871717. Archived (PDF) from the original on 27 September 2011. Retrieved 5 November 2009.
  2. 1 2 3 Akkuzu, Guzin; Babur Akkuzu; Erdinc Aydin; Murat Derbent; Levent Ozluoglu (20 September 2007). "Congenital partial arrhinia: a case report". Journal of Medical Case Reports. 1 (1): 97. doi: 10.1186/1752-1947-1-97 . PMC   2064923 . PMID   17883831.
  3. "Aplasia of the nose (Concept Id: C0265740)". www.ncbi.nlm.nih.gov. Retrieved 7 August 2023.
  4. 1 2 3 Shaw, Natalie; Graham, John M. Jr. (27 April 2020). "Bosma Arhinia Microphthalmia Syndrome". Rare Diseases.[ permanent dead link ]
  5. 1 2 3 4 Zhang, Mao-mao; Hu, Yang-hong; He, Wei; Hu, Kui-kui (18 March 2014). "Congenital arrhinia: A rare case". The American Journal of Case Reports. 15: 115–118. doi:10.12659/AJCR.890072. PMC   3966695 . PMID   24678375.