Bilateral facial nerve palsy is a rare neurological condition in children and is infrequently associated with primary Varicella (chickenpox) infection. We report the case of a 10-year-old previously healthy girl who developed simultaneous bilateral lower motor neuron facial weakness 3 weeks after a self-limiting varicella infection. The patient presented with acute onset inability to close both eyes, difficulty smiling, drooling of saliva, and impaired oral competence. At presentation, the characteristic vesicular rash had completely resolved. Neurological examination demonstrated bilateral lower motor neuron facial nerve palsy with loss of forehead creases, lagophthalmos, flattening of the nasolabial folds, inability to puff the cheeks, and bilateral Bell's phenomenon, without additional neurological deficits. Laboratory investigations and brain magnetic resonance imaging (MRI) were unremarkable. Based on the temporal relationship with recent varicella infection and exclusion of alternative etiologies, a diagnosis of bilateral facial nerve palsy secondary to varicella-zoster virus infection was established. The patient was treated with intravenous aciclovir, corticosteroids, supportive eye care, and facial physiotherapy. Follow-up after 6 weeks demonstrated marked clinical improvement, including restoration of facial symmetry, improved eye closure, recovery of smiling ability, and resolution of drooling. This case highlights a rare neurological complication of primary varicella infection and emphasizes the importance of early recognition and multidisciplinary management to achieve favorable neurological outcomes.

Background and Objectives: Presurgical infant orthopedics aims to reduce cleft severity and facilitate primary surgical repair during the early neonatal period, when increased tissue plasticity enhances molding. Nasoalveolar molding is widely used but requires intraoral appliances, laboratory support, specialized training, and frequent follow-up visits, which may limit accessibility and adherence. This case series reports the clinical application of presurgical lip-alveolus-nose approximation (PLANA), an extraoral technique for early presurgical cleft management, and describes the clinical changes observed during treatment in four infants. Materials and Methods: A prospective case series conducted in neonates with non-syndromic unilateral or bilateral cleft lip and/or palate referred within the first 10 days of life to the Alabama Cleft Center. Treatment consisted of a prefabricated silicone nasal aligner combined with hydrocolloid lip adhesive taping. No intraoral plates or dental impressions were used. Devices were worn 20 to 22 h daily. Follow up occurred every 2 to 4 weeks, with remote monitoring used when appropriate. Qualitative clinical observations focused on apparent changes in nasal symmetry, columellar length, septal alignment, nasal tip projection, premaxillary position, nostril dimensions, alar base width, cleft width, and lip approximation, as well as feeding tolerance, skin tolerance, and treatment adherence. These observations were assessed qualitatively through serial clinical examinations and clinical photographs; no standardized quantitative morphometric measurements were performed. Results: Four infants with complete unilateral or bilateral cleft lip and palate received PLANA treatment. Serial clinical examinations and photographs documented qualitative changes in nasolabial morphology over the course of treatment in all four patients. Qualitative clinical assessment of serial photographs and examinations suggested greater apparent nasal symmetry, apparent columellar elongation, more central-appearing nasal alignment, increased apparent nasal tip projection, apparent cleft-width reduction, and progressive lip approximation. In unilateral clefts, changes were observed in both the cleft and non-cleft nasal sides, while bilateral clefts demonstrated changes in nasal morphology bilaterally. No device-related complications or clinically significant skin intolerance were documented during the reported treatment periods. Parent-reported device wear was approximately 20-22 h per day. Conclusions: In this four-patient prospective descriptive case series, PLANA was applied clinically, with no clinically significant treatment-related complications documented during the reported treatment periods. Serial clinical observations suggested changes in nasolabial morphology during treatment. Given the small sample size, absence of a contemporaneous control group, and qualitative nature of the assessments, these findings should be interpreted as preliminary and hypothesis-generating rather than as evidence of treatment efficacy or comparative effectiveness. Larger prospective, multicenter comparative studies incorporating standardized quantitative measurements, objective adherence assessment, and long-term surgical and aesthetic outcomes are needed to evaluate the effectiveness, reproducibility, and clinical applicability of the PLANA approach.

Schwannoma is a benign, encapsulated, slow-growing tumor that arises from Schwann cells. Approximately 25%-45% of extracranial schwannomas occur in the head and neck region, accounting for 1%-8% of all neoplasms. However, involvement of the infraorbital nerve is exceptionally rare. This report describes the surgical management of an infraorbital nerve schwannoma using a transconjunctival approach with lateral canthotomy, and documents the clinical, functional and aesthetic outcomes at 12 months. A 32-year-old woman with a history of hypochromic microcytic anemia presented with a progressively enlarging mass in the right infraorbital region that had been present for four years, associated with mild paresthesia in the nasolabial region. The main reason for consultation was aesthetic concern due to facial protrusion. Physical examination revealed a firm, painless subcutaneous mass without local inflammatory signs. Contrast-enhanced computed tomography revealed a solid, lobulated lesion measuring approximately 60 mm in maximum diameter in the right infraorbital region. Imaging features suggested an origin from the infraorbital foramen and involvement of the corresponding nerve; there was no evidence of osteolysis. Fine-needle aspiration cytology (FNAC) suggested a mesenchymal neoplasm. Surgical excision was performed under general anesthesia via a transconjunctival approach with lateral canthotomy. The infraorbital nerve was identified and preserved intraoperatively. Histopathological examination confirmed a schwannoma, showing spindle-shaped cells with Verocay bodies. The patient had a favorable clinical course. At the 12-month follow-up, facial symmetry and preserved sensory function were confirmed, as was the absence of recurrence.

Presurgical lip, alveolus, and nose approximation (PLANA) is a form of presurgical infant orthopedics designed to reduce cleft severity without an intraoral molding plate. This study compared nasolabial outcomes and the burden of care in patients with a bilateral cleft treated with PLANA in relation to nasoalveolar molding (NAM). A single-institution retrospective review was conducted of all patients with bilateral cleft lip treated with NAM (2016-2019) or PLANA (2023-2025). Clinical data were collected, including treatment timing, number of visits, and number of unscheduled appointments. Anthropometric measurements for nasolabial angle (NLA), columella length, pronasale to subnasale distance, and alar base width at initiation and completion of therapy were collected. Paired-samples t tests were used for intragroup changes, and independent-samples t tests were used for intergroup comparisons. Across 24 patients (11 PLANA and 13 NAM), the PLANA cohort required fewer visits (6 versus 17, P<0.05) and unscheduled appointments (0 versus 1, P=0.01). Treatment initiation occurred earlier in the PLANA group (11 versus 35 d, P<0.05), as did the insertion of the nasal appliance or stent (19 versus 72 d, P<0.05). Primary surgery was performed earlier in the PLANA group (107 versus 150 d, P<0.05). Both groups exhibited improvements in NLA, columella length, and the pronasale-to-subnasale difference, with no intergroup differences. The PLANA group exhibited greater improvement in alar base width (3.3 versus 0.4 mm, P=0.01). Patients treated with PLANA exhibit favorable nasolabial outcomes, as well as reduced treatment durations, scheduled visits, unscheduled appointments, and overall burden of care.

Secondary nasolabial aesthetic revision after cleft lip surgery requires coordinated assessment of scar-related contracture, lip subunit distortion, and cleft nasal deformity. Traditionally, these 2 aspects have been managed separately. This narrative review summarizes a focused, revision-oriented framework in which scar management is considered as an adjunct to staged nasolabial subunit reconstruction rather than as an isolated therapeutic goal. Early scar-directed measures, including tension reduction, silicone-based therapy, pulsed-dye laser, and selected pharmacologic interventions, may improve tissue quality and reduce contracture before definitive revision; however, their use should be individualized because evidence and timing remain heterogeneous. For established secondary deformities, definitive revision focuses on the philtrum, Cupid's bow, vermilion, alar base, columella, and nasal tip using local flaps, cartilage grafting, soft-tissue rearrangement, and orbicularis oris reorientation. This approach restores 3-dimensional (3D) symmetry and natural landmarks. Digital technologies such as 3D photogrammetry, finite element analysis (FEA), and artificial intelligence (AI) enable objective scar assessment and personalized surgical planning. However, current limitations remain, including the absence of a cleft lip-specific scar scale, insufficient long-term follow-up data, and unresolved timing of early interventions in infants. Overall, this review reframes scar management as one component of secondary nasolabial revision and emphasizes subunit-based reconstruction, individualized timing, and cautious interpretation of the available evidence.

Nasolabial cysts are rare, benign, nonodontogenic, extraosseous maxillofacial lesions, with bilateral involvement being uncommon. A 40-year-old woman presented with long-standing bilateral nasal vestibular swelling. Magnetic resonance imaging (MRI) demonstrated well-defined bilateral cystic lesions along the nasal floor with characteristic signal intensities and smooth anterior maxillary bone scalloping, consistent with bilateral nasolabial cysts containing internal debris. This case highlights the characteristic MRI appearance of bilateral nasolabial cysts and emphasizes the role of MRI in accurate diagnosis and surgical planning.