Proboscis Lateralis is a rare congenital anomaly, which is embryologically related to the median facial cleft, and may be associated with other anomalies of the eye and its adnexa and cleft lip and palate.A child with Group three proboscis lateralis was treated by using the flaps of the proboscis lateralis, one for the correction of maxillary hypoplasia and the other for correction of the grooving in the nasolabial region.This technique helped in achieving a good cosmetic outcome.Various methods have been suggested for the treatment of proboscis lateralis, ranging from the extirpation of the proboscis, to the tunneling method. We have suggested the use of the flaps from the proboscis, which gave us the advantage of a one-stage correction of the proboscis along with the maxillary hypoplasia, and to minimize the grooving in the nasolabial region. Introduction Proboscis lateralis is a rare congenital anomaly, which is embryologically related to the median facial cleft 1,2,3,4 . Various craniofacial anomalies are associated with it, apart from hemi nasal aplasia or hypoplasia. The reported incidence of proboscis lateralis is less than one per 100,000 live births, without any sexual preference 2 . The proboscis may be unilateral as well as bilateral, the former being the more common type 1,3,6,7,8,10. There is a tube like rudimentary nasal structure which is attached along the embryonic fusion lines between the anterior maxillary process and the frontonasal process 1,5 . The length of the proboscis may vary from 1 to 4 cms in length 1,3 . It has a stratified columnar lining and ends as a blind tract, without any connection with the nasal cavities. According to Boo- Chai 6 and Guerrero et al., 7 it was Forster who first mentioned this anomaly in his monograph entitled “ Congenital anomalies of the human body” in 1861. However, according to Binnis, 8 Selenkoff is believed to be the first, since his detailed report of the autopsy findings of a farmer patient with proboscis was published in 1884 23 . The patient had lacked the right nasal bone, right frontal and maxillary sinus, vomer, premaxilla, right upper second incisor, and the right lateral nasal wall. Antenatal diagnosis is now possible with development in radio diagnostic techniques 4 MRI and CT studies have shown that there are rudimentary nasal bones, and the ethmoids and the frontal sinus may be absent as well. There may be associated CNS anomalies. For the complete evaluation of the anomaly CT or MRI is important as it allows for assessment of the growth of the facial and skull bones as well as the Central nervous system development. 11 This malformation is almost always associated with anomalies of the eye and its adnexa, and may also be rarely associated with a cleft lip or cleft palate. Khoo Boo Chai collected 34 cases from literature, classified them into four groups, discussed various management options and advised dilatation of proboscis before starting the reconstruction 6 . The four groups are as follows: Group 1 consists of Proboscis with normal nose. Group 2 consists of Proboscis with nasal defect only on the same side. Group 3 consists of Proboscis with ipsilateral nasal defect is associated with eye or adnexal defects. It is the most common type. Group 4 consists in addition to the nasal and ocular defect, a cleft of the lip or the palate. Proboscis lateralis necessitates surgical treatment. Management should start early in the childhood to avoid psychosocial consequences related to this deformity. Complete aesthetic outcome may be delayed until late teens when growth of the nasal skeleton is almost complete 6,25 . For the hemi nose reconstruction, use of proboscis itself is the best option. Later secondary procedures may be required to correct skeletal deformities. Although many surgical techniques have been described, there are two eminent techniques. According to Denecke and Meyer, 1 Young was the first to mention correction of proboscis in literature in 1949
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