Nasal deformity, a common occurrence in unilateral and bilateral cleft lip and cleft palate patients, is a formidable challenge for the cleft surgeon. The underlying abnormal anatomy, aggravated by tissue scarring and loss of facial planes after primary procedures, makes secondary rhinoplasty a difficult procedure for even the most experienced. Over the past years, numerous techniques for secondary cleft rhinoplasty have been described in literature. Regardless of the technique adopted, the fundamental goal of cleft rhinoplasty is to achieve a nose that would be esthetically accepted in society as well as functionally accepted by the patient. The correction of nasal deformity can be performed with a closed or an open technique. This article highlights the open technique used for secondary rhinoplasty for a challenging case of unilateral cleft lip nasal deformity in an adult patient.
Panoramic radiographs of male patient revealed the presence of bilateral impacted fourth molars in mandibular region. The supernumerary teeth were distomolars and had normal tooth morphology with regard to their crowns and roots but were slightly smaller than the existing third molars. Their crowns were three tuberculate and they all had single roots. Supernumerary teeth are often located in the anterior maxilla, mandible, and to a lesser frequency posterior of the maxillary and mandibular region. They are classified as distomolar when they are located in posterior to their location. Their presence may or may not give rise to a variety of clinical problems. Detection of supernumerary teeth is usually achieved by clinical and radiographic examination. Their management should form part of a comprehensive treatment plan. A fourth molar tooth is a very rare entity in modern humans although prevalent in early humans. This article presents a case report in a non-syndromic patient with bilateral impacted mandibular distomolar; aberrations associated with supernumerary teeth and also a note on their incidence and prevalence.
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