Nasal fossa malformations and paramedian facial cleft: New perspectives

Choanal atresia may be associated with other cranio-facial malformations, i ncluding various degrees of nasal fossa malformation, and may be a part of paramedian facial clefts (as described by Tessier et al. [1977]). We identi fied five such cases with combined clinical elements corresponding to Tessi er's paramedian facial cleft, including eyelid coloboma, mild to severe cho anal and nasal fossa anomalies, ethmoidal hypoplasia and anterior skull bas e malformation, sometimes with proboscis lateralis and half-nose hypoplasia . These observations incited us, first, to elaborate a conception which accou nts for the likely embryological mechanisms involved; second, to propose a new classification based on anatomical and pathogenic embryological conside rations; and last, to propose the use of transpalatal approach to restore c hoanal permeability, since endonasal laser therapy is particularly dangerou s in such cases.