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In case of First son, it revealed annular papules, annular plaques with central clearing and raised peripheral edge of different sizes varying from 2mm to 20 mm over dorsum of nose and ala nasi, distributed bilateral symmetrically (Figures 2 and 3).
Advantages of open approach is that it offers an excellent exposure of dorsum of nose and allows the surgeon to see directly what he is sculpturing, graft lies away from the incision site and hence risk of extrusion is avoided.
Complications occur when maggots eat away the tissues creating submucosal tunnels in nose, nasopharynx, posterior pharyngeal wall, medial orbital plate, rarely dorsum of nose and may produce palatal perforation.