Li et al. Journal of Medical Case Reports 2011, 5:583 http://www.jmedicalcasereports.com/content/5/1/583 Page 3 of 5 Figure 5 Atresia of the right posterior naris under the nasal endoscopy. Figure 7 Ethmoid osteoma. A white bony mass in his left ethmoid sinus was identified clearly during the operation. Closed rhinolalia and sleep snoring were all remarkably relieved. Discussion Congenital accessory nasal deformity is a supernumerary malformation in the external nose. Supernumerary mal- formation may appear in different ways. It may replace the normal structure or co-exist with it. Removal of the congenital accessory is the optimal treatment method. Tambwekar [3] reported one similar case. The patient in our report bore three anterior nares, however, this should be differentiated from three-nostril malforma- tion, a type of cleft nose occurring when the median line of the nasal ridge presents as a major groove, or the mesenchymal tissue between two olfactory saccus fails to evolve into a thin but firm septal cartilage in the embryonic period, resulting in the nasal dorsum broadening and the cleft emerging. In our case, only the soft tissue formed the malformation in one side of the anterior nares, therefore this case was diagnosed as ‘con- genital accessory nasal deformity’. Congenital atresia of the posterior nares can be cate- gorized into two types: unilateral (60%) and bilateral (40%) atresia [4]. According to the closure tissue, it can be subdivided into membranous, bony or mixed bony- membranous atresia [5]. Although the incidence of con- genital atresia of posterior nares is low, other congenital abnormalities often coexist [6]. In the case of our patient, congenital keratoleukoma of the right eye was an accompanying abnormality. Burrow et al. [7] stated that 26.4% of the choanal atresia they found was iso- lated, while 73.6% was associated with other anomalies. CHARGE syndrome may manifest with choanal atresia [8]. However, according to Verloes [9], our patient Figure 6 The right anterior naris postoperation. After the diaphragm was removed, the right anterior naris was recovered. Figure 8 Microphotograph of the tumor. Hematoxylin and eosin stain (original magnification ×20).