Bifid nose

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.

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.

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]

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]

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]

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]

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]

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]

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

• Cleft palate
• Cleft lip
• Cleft chin