Li et al. Journal of Medical Case Reports 2011, 5:583 http://www.jmedicalcasereports.com/content/5/1/583 Page 2 of 5 Figure 1 Congenital right accessory nasal deformity. The right anterior naris was divided into two parts by a barrier diaphragm protruding from a lateral wall. During the surgery, we found his right anterior naris was divided into two parts by a barrier diaphragm. The lateral part of the right anterior naris was a caecum and did not open to the nasal cavity. After the diaphragm was removed, the right anterior naris was recovered (Figure 6). Under nasal endoscopy, the uncinate process, ethmoid bulla and air cells were removed. The maxillary sinus ostium was opened to locate the plane of the lamina papyracea. Then, inside the ethmoid sinus, a white bony mass was identified clearly (Figure 7) and resected com- pletely. The bony mass was irregular in shape, pale in color, and difficult to remove from the middle meatus. Figure 3 Ethmoid osteoma. CT revealed a high-density bony shadow in his left ethmoid sinus. Its size was about 2.2 cm × 1.8 cm × 2.0 cm. The roof of the ethmoid and cribriform plate was examined carefully and found to be intact. Neither leakage of cere- brospinal fluid nor active bleeding occurred. Dense osteocarcinoma was diagnosed by postoperative pathol- ogy (Figure 8). A soft and elastic membrane was found to block both posterior nares. A cruciate incision was made in the membrane center and the openings were widened to the bony part of the posterior nares. A silica gel about 0.8 cm in diameter and 7 cm in length, with multiple holes in the lateral wall, was placed bilaterally from anterior to posterior nares to prevent re-stenosis. The silica gel was removed six weeks later. After more than three years of follow-up, both anterior and posterior nares were capacious and nasal ventilation was normal (Figures 9 and 10). Olfactory function recovered partially. Figure 2 Bilateral choanal atresia in axial C. Atresia CT revealed bilateral choanal atresia. Figure 4 Congenital keratoleukoma of his right eye. The cornea of his right eye was covered by keratoleukoma.