Images in Clinical Practice

Indian Pediatrics 1999;36: 1173

Three Nostril Nose


A two-day-old male child,born of consanbuineous parentage presented with the complaint of stridor since birth.On examination ,the child had three nostrils (Fig.) Each nostril was seperated by a wall.The hard palate was thick and had no cleft.The soft palate and uvula were normal.There was stenosis of posterior choana.There were no other anomalies.The child's cry and sucking were normal and vigorous.Hearing appeared to be normal clinically.The chest X-ray and abdominal sonogram were normal.

Two earlier sibling too had anomalies.Both were born with bilateral absence of external ears.

Fig. 1. Blisters and raw ulcerative lesions all over the body and crusts around her nostrils and oral cavity.

A.Ramachandraiah,
A. Chakravrthi,
Child Care Center,
Cuddapah 516001,
Andhra Pradesh,
India
.

Indian Pediatrics 1999;36: 1173-1174

Osteogenesis Imperfecta Tarda Type IV

 

A 15 year old boy was admitted with history of cough & breathlessness off and on.The patient was a product of consanguineous marriage.The  mother had 4 still births and this was the only living child.The child had repeated fractures till age of 2 to 3 years.
Physical examination revealed a boy with hort stature (length of 111 cm against an expected 60 cm),large head,blue sclera,kyphoscoliosis,high arched palate,pectus carinatum and multiple bony deformities (Fig. 1)The boy was mentally normal and had passed 10th class examination.X-ry of the right leg reveled bony deformity involving both tibia and fibula (Fig 2) and chest X-ray showed kyphoscoliosis.

f11174.jpg (16737 bytes)     f21174.jpg (11793 bytes)

Fig. 1. Clinical photograph showing blue sclera,kyphoscoliosis, pectus carinatum and having deformity of right leg. Fig.2. X-ray of right leg showing bowing deformity of tibia and fibula.

Osteogenesis imperfecta type IV  is autosomal dominant and les lethal unlike types I , II ,III which are autosomal recesive and more lethal.Those with type I and type IV osteogenesis imperfecta show spontaneous improvement  at puberty and may hve few fractures in adolesence and adulthood.

Sanjeev Joshi,
Consultant,
Vakil Chawl,Gadag 582101,
Karnataka,
India.

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