Nasal dorsum fistula is a rare condition in which a small opening or tract forms along the bridge of the nose, and it is usually present from birth. Early symptoms of nasal dorsum fistula can include a tiny pit on the skin, repeated drainage, swelling, or infections near the midline of the nose. It is most often recognized in infants or children, but some people with nasal dorsum fistula are not diagnosed until later if symptoms are mild. Not everyone will have the same experience. Treatment is usually surgery to remove the tract and prevent recurrent infection, and death from nasal dorsum fistula is very uncommon but the risk can rise if a connected infection spreads deeper.
How many people live with Nasal dorsum fistula?
Nasal dorsum fistula, a rare small tunnel or opening on the bridge of the nose, does not have a reliable published estimate for how many people are living with it worldwide or in the United States. This condition is described mostly in small case reports and surgical case series, so global and U.S. counts are not consistently reported by a single authoritative source.
Overview
Nasal dorsum fistulaSymptoms
Nasal dorsum fistula often appears as a tiny opening or pit on the bridge of the nose, sometimes with a small hair tuft. Many living with nasal dorsum fistula have intermittent drainage, swelling, redness, or repeated skin infections.
Outlook and prognosis
With treatment, the outlook for nasal dorsum fistula is usually very good. Most people recover fully after surgery, although some may need follow-up if the tract is deeper, infected, or linked to nearby structures.
Causes and risk factors
Nasal dorsum fistula is usually present from birth and happens when facial tissues do not fully join early in development. Most cases are sporadic, though rare familial cases can occur. Lifestyle and environmental factors are not known causes, but infection or trauma can worsen problems.
Genetic influences
Genetics do not seem to play a major role in nasal dorsum fistula. Most cases are thought to happen sporadically during early development, with no clear inherited pattern or common gene change identified.
Diagnosis
Nasal dorsum fistula is usually diagnosed from clinical features, such as a small midline nasal opening or drainage. Imaging, often MRI or CT, helps confirm the diagnosis of Nasal dorsum fistula and shows how deep the tract goes.
Treatment and drugs
Treatment for nasal dorsum fistula usually involves surgery to remove the tract and close the opening, which can help prevent repeat drainage and infection. Antibiotics may be used if the area is infected before or after the procedure.
Symptoms
A tiny spot on the bridge of the nose may not seem important at first, but it can keep crusting, leaking, or getting sore. In medical terms, this is a nasal dorsum fistula; in everyday life, it often looks like a small midline pit or opening on the nose. The early features of nasal dorsum fistula are often present from birth, although some people are only diagnosed later when swelling or infection starts. A healthcare professional can help sort out what’s typical skin irritation and what warrants a closer look.
A tiny hole, dimple, or pin-point pit often sits in the middle of the nasal bridge. It may look like a stubborn blackhead or enlarged pore and can be easy to overlook.
Clear, yellow, or oily material may come out from the opening from time to time. This can dry into crusts, stain tissues, or sometimes have an unpleasant smell.
A small lump or fullness can form under the skin when material collects in the channel. Some may find that the area puffs up for a while and then settles down again.
If the area becomes infected, the skin may turn red, warm, and tender. Pus, a rapidly enlarging bump, or fever can happen with a more significant infection.
How people usually first notice Nasal dorsum fistula?
How nasal dorsum fistula is first noticed often comes down to a small pit, dimple, or tiny opening along the bridge of the nose that is present at birth or seen in early childhood. Families or doctors may also notice a fine hair sticking out of the opening, a small lump under the skin, or intermittent drainage of clear fluid or pus, especially if the tract becomes infected. For many people with a nasal dorsum fistula, these first signs of nasal dorsum fistula lead to medical evaluation when the area repeatedly swells, becomes red and tender, or does not heal like a simple skin spot.
Types of Nasal dorsum fistula
No distinct types of Nasal dorsum fistula are widely recognized.
Can I slow down the onset of symptoms?
Usually no: a nasal dorsum fistula, meaning a small abnormal tunnel or opening on the bridge of the nose, is usually present from birth, so there is no good evidence that diet, exercise, sleep, or other lifestyle changes can meaningfully delay when symptoms begin. Keeping the area clean and getting redness, swelling, drainage, or infection treated early may help reduce flare-ups and lower the chance of complications, but that is not the same as preventing the condition. The main medical option is early evaluation by an ear, nose, and throat team or a plastic surgeon, because surgery is the standard treatment; acting early may help avoid repeated infections, even though it cannot guarantee a certain outcome.
What genetics can tell you about symptoms
For most people with a nasal dorsum fistula, genetics cannot reliably predict which symptoms will happen, how severe they will be, or when they will start, because this condition is usually a structural difference present from birth rather than a disorder with a well-defined inherited pattern. Symptoms such as a small opening on the bridge of the nose, drainage, swelling, or repeated infections are more closely linked to the size and depth of the tract than to known gene changes. In rare cases, a nasal fistula can appear as part of a broader genetic or developmental syndrome, and then genetics may help explain the overall pattern of findings, but this is not the usual reason symptoms vary.
Causes and risk factors
Most cases of nasal dorsum fistula start before birth, when tissues in the bridge of the nose do not close in the usual way. This leaves a small skin-lined tunnel that can connect to deeper tissue. Family history can be one part of the story, but a clear inherited cause is uncommon. Less often, nasal dorsum fistula develops after injury, surgery, or a deep infection of the nose. There are no well-proven lifestyle risks, and nothing a parent did during pregnancy is known to cause it.
What are the most common causes or risk factors?
Most nasal dorsum fistulas are present from birth and happen because the tissues along the bridge of the nose do not join and separate normally while the baby is developing, which can leave a tiny tunnel under the skin. They usually are not caused by anything a parent did, and most cases do not clearly run in families, although a family history of similar midline birth differences may raise the chance in rare cases. Less often, a fistula on the bridge of the nose can develop after an injury, surgery, or a deep infection in that area.
Environmental and biological risk factors
Nasal dorsum fistula is usually linked to events very early in fetal development, when the nose and nearby midline structures are forming. Doctors often group risks into internal (biological) and external (environmental). If you are looking into what causes nasal dorsum fistula, the clearest evidence points to early biological development, while proven environmental triggers are limited.
Nasal dorsum fistula is linked to incomplete separation of tissues in the developing nose before birth. This can leave an abnormal passage connecting the skin to deeper tissue.
Changes in how the center of the face forms can increase the chance of nasal dorsum fistula. These changes happen very early in pregnancy, often before someone even knows they are pregnant.
Babies with other midline differences of the nose, face, or front of the skull may be more likely to have nasal dorsum fistula. This suggests a shared early developmental pathway rather than a problem that starts later in life.
No specific outside exposure has been consistently proven to cause nasal dorsum fistula. At this time, clear environmental risk factors have not been firmly established.
Genetic risk factors
For many families, the main question is why a tiny opening or draining spot appeared on the bridge of the nose in the first place. Nasal dorsum fistula is usually a congenital difference, meaning it forms very early in pregnancy as the middle of the face develops. In most cases, the genetic causes of nasal dorsum fistula remain unclear, and no inherited change is found. Carrying a genetic change doesn’t guarantee the condition will appear.
Mostly sporadic: Most people with nasal dorsum fistula do not have a known inherited gene change or a strong family history. This suggests many cases happen sporadically during early facial development before birth.
Family history: Rare families have more than one relative with a midline nasal tract or a closely related facial difference. This can point to an inherited tendency, but it is uncommon and the exact gene is often still unknown.
Rare syndromes: Nasal dorsum fistula can sometimes be one feature of a broader inherited condition that affects how the middle of the face forms. When there are other differences present at birth, doctors may suggest a genetics evaluation to look for an underlying syndrome.
Lifestyle risk factors
Lifestyle habits do not cause a nasal dorsum fistula, which is usually present because of developmental changes before birth. Still, how lifestyle affects nasal dorsum fistula can matter because daily habits may influence skin irritation, blockage, drainage, infection risk, and recovery after treatment. The main lifestyle risk factors for nasal dorsum fistula involve local skin care, touching or manipulating the area, smoking, general nutrition, and following medical advice when symptoms change.
Inconsistent cleansing can allow oil, sweat, and surface bacteria to build up around the opening. This may increase irritation, foul-smelling discharge, or local infection in a nasal dorsum fistula.
Repeated touching, squeezing, or trying to drain the tract at home can inflame the tissue. This can worsen swelling, bleeding, pain, and infection risk.
Thick makeup, oily creams, or occlusive facial products over the area may block drainage from the fistula opening. When material cannot drain well, tenderness and recurrent inflammation may become more likely.
Smoking can impair blood flow and slow normal tissue healing. In people with a nasal dorsum fistula, this may raise the chance of persistent inflammation and poorer healing after surgery.
Risk prevention
For most people, a nasal dorsum fistula cannot be truly prevented because it usually forms before birth as the nose develops. Prevention is mainly about lowering the chance of infections, drainage problems, and deeper complications by spotting it early and getting proper care. Many living with nasal dorsum fistula first notice a tiny pit or repeated swelling on the bridge of the nose, and early symptoms of nasal dorsum fistula should be checked rather than watched for months. Prevention is flexible—it adapts to your life and health background.
If a small opening, lump, or repeated discharge appears on the bridge of the nose, have it assessed promptly. Early diagnosis of nasal dorsum fistula can help prevent repeated infections and damage to nearby tissues.
Picking, squeezing, or trying to drain the area at home can push bacteria deeper and make inflammation worse. Keeping hands off a nasal dorsum fistula lowers the risk of pain, redness, and scarring.
Redness, tenderness, swelling, fever, or pus should be treated quickly with medical care. Fast treatment can reduce the chance that a nasal dorsum fistula infection spreads into deeper structures.
When doctors confirm a nasal dorsum fistula, complete surgical removal is often the best way to prevent repeat infections and ongoing drainage. Surgery is usually planned carefully, sometimes with imaging first, to make treatment safer and more complete.
Can you prevent Nasal dorsum fistula?
Usually, no. A nasal dorsum fistula, which means an abnormal small passage or opening on the bridge of the nose, is most often something a baby is born with, so there is no proven way to prevent it. In the less common cases that happen after an injury, infection, or surgery, getting prompt care and following wound-care advice may lower the risk, but it cannot fully prevent it.
Transmission
Nasal dorsum fistula is not contagious, so it cannot be passed from one person to another through touch, coughing, kissing, or everyday close contact. In most cases, it develops before birth when tissues in the middle of the nose do not form in the usual way, rather than from an infection or anything a parent did.
For many living with this condition, the main question is how nasal dorsum fistula is inherited, and the answer is that it is usually not clearly passed down in families. Most cases appear to be isolated, although rare familial cases have been reported, so if there is a family history of similar midline facial differences, a genetics specialist can talk through the chance of it happening again in another pregnancy.
When to test your genes
Genetic testing is not usually part of care for a nasal dorsum fistula, because it is typically a structural birth difference rather than a known inherited disorder. Testing may be worth discussing if there are other congenital differences, developmental concerns, or a family history that suggests an underlying syndrome.
Diagnosis
A nasal dorsum fistula is usually diagnosed when a small opening, pit, or draining spot on the bridge of the nose keeps coming back or never fully goes away. In many living with this condition, the first clue is repeated swelling, discharge, or a bump that seems to flare and settle over time. Getting a diagnosis is often a turning point toward answers and support. The diagnosis of nasal dorsum fistula is based on the exam and imaging to see whether the tract stays near the skin or extends deeper.
Doctors carefully inspect the bridge of the nose for a tiny skin opening, swelling, redness, or drainage. They also feel for an underlying tract or cyst and look for signs of infection or repeated inflammation.
Your provider asks when the spot was first noticed and whether there have been episodes of discharge, tenderness, or swelling. A detailed family and health history can help, although this condition is usually found based on its appearance rather than family pattern.
MRI or CT scans are often used to map the fistula tract and check whether it connects to deeper tissues. This is especially important before surgery, because some tracts extend toward the nasal bones or, rarely, toward structures inside the skull.
In some cases, ultrasound can help show a superficial cyst or tract under the skin. It may be useful in children or when doctors want a quick first look before more detailed imaging.
How is Nasal dorsum fistula diagnosed?
Nasal dorsum fistula is usually diagnosed when a doctor examines the bridge of the nose and asks about signs like a tiny opening or pit, drainage, swelling, or repeated skin infections in the same spot. Imaging tests, most often an MRI and sometimes a CT scan, are used to see how deep the narrow tunnel under the skin goes and to check whether it reaches toward the bones near the brain. In most cases, the diagnosis comes from the exam plus imaging, rather than from blood tests or genetic testing.
Stages of Nasal dorsum fistula
Nasal dorsum fistula does not have defined progression stages. This is because it is usually a structural problem present from birth rather than an illness that moves through set phases over time. Often the process begins when you notice changes in daily life, such as a tiny opening or pit on the bridge of the nose, repeated drainage, swelling, or infections, which can overlap with early symptoms of nasal dorsum fistula. Doctors usually diagnose nasal dorsum fistula with a physical exam and often use imaging, such as MRI or CT scans, to see how deep the tract goes and to plan treatment safely.
Outlook and prognosis
The outlook for people with a nasal dorsum fistula is generally excellent when it is fully evaluated and completely removed surgically. Most patients do very well after treatment, with good cosmetic and functional results and a low risk of long-term problems. Prognosis is less favorable if the tract is not completely excised, because recurrence and repeated local infections can occur. In cases with deeper extension toward the skull base or intracranial structures, outcomes still can be good, but surgery is more complex and the risks of complications such as meningitis are higher if treatment is delayed. Mortality is very uncommon and is usually not expected in properly treated cases, but severe untreated infection or intracranial complications could rarely become life-threatening. Early imaging and specialist surgical care are the main factors associated with the best outcome.
Long-term effects
For many living with nasal dorsum fistula, the long-term picture depends mostly on whether the tract is fully treated and whether it extends deeper toward the skull. Long-term effects vary widely, from little ongoing trouble after treatment to repeated local problems when the opening stays present. The long-term effects of nasal dorsum fistula most often involve drainage, infection, appearance changes, and, in a small number of cases, complications tied to deeper extension.
A small opening on the bridge of the nose can keep leaking fluid, skin oils, or tiny hairs over time. This may be intermittent, so some people go through stretches with little trouble and then notice the area acting up again.
Bacteria can enter through the tract and cause repeated redness, swelling, tenderness, or pus. If this keeps happening, the surrounding skin may become more irritated and harder to heal fully.
Ongoing inflammation can leave visible skin changes such as thickening, discoloration, or a small scarred pit. Many people with nasal dorsum fistula find that repeated irritation makes the area more noticeable over the years.
Even when the tract is not infected, a bump, pit, or asymmetry along the nasal bridge can remain a lasting feature. For some, this can affect confidence because the change sits in a very visible part of the face.
How is it to live with Nasal dorsum fistula?
Living with a nasal dorsum fistula often means dealing with a small opening or tract on the bridge of the nose that may drain fluid, become irritated, or get infected from time to time, which can be uncomfortable and sometimes embarrassing in everyday social settings. For many people, daily life is mostly normal between flare-ups, but repeated swelling, tenderness, discharge, or the need to keep the area clean can be frustrating, and families may also worry about infections or about whether surgery will be needed. If the fistula is repaired successfully, many living with this condition go on to have little or no long-term effect on daily life.
Treatment and drugs
Nasal dorsum fistula is usually treated by removing the small abnormal tract under the skin, because the opening on the bridge of the nose tends to keep draining or get infected if it is left in place. Treatment often looks different for each person, but surgery is the main treatment and is usually planned after a specialist examines the area carefully and, if needed, orders imaging to see how deep the tract goes. If there is redness, swelling, pain, or drainage, doctors may first use antibiotics to calm an infection before surgery rather than operating through inflamed tissue. After treatment, many people need simple wound care and follow-up visits to make sure the area heals well and does not come back.
Can you cure Nasal dorsum fistula?
Often, yes. A nasal dorsum fistula, which is a small abnormal tunnel or opening on the bridge of the nose, can often be cured with surgery to remove the tract and close it; if there is an infection or another underlying problem, that also needs treatment. In some people, follow-up care is needed to make sure it does not come back.
Non-drug treatment
A small opening or tract on the bridge of the nose can lead to repeated drainage, swelling, or skin infections, and that day-to-day irritation is often what brings people in for care. In nasal dorsum fistula, non-drug care mostly centers on careful evaluation, protecting the skin, and surgery to remove the tract fully when needed. For many, treatment begins not at the pharmacy, but with seeing an ear, nose, and throat surgeon or plastic surgeon to map the tract and plan the safest approach. Because some fistulas extend deeper than expected, early treatment for nasal dorsum fistula usually focuses on confirming the anatomy before anything is done.
Care usually starts with a detailed exam by an ENT, facial plastic, or craniofacial team. This helps confirm that the opening is a nasal dorsum fistula and checks for signs that the tract may run deeper.
MRI and sometimes CT scans are often used to show where the tract goes and whether it connects to deeper structures. This planning step is especially important before surgery, because the outside opening may look small while the tract extends farther inside.
Gentle cleansing and keeping the area dry can help reduce crusting, odor, and irritation from ongoing drainage. People with nasal dorsum fistula should avoid squeezing, probing, or trying to clear the tract at home, which can worsen inflammation.
Surgery is the main non-drug treatment because it aims to remove the whole tract rather than just treat the surface problem. Not every approach works the same way, and the exact operation depends on how deep the fistula runs and whether nearby bone or tissue is involved.
Your genes may have an impact on how drugs work for you
For people with a nasal dorsum fistula, medicines are usually used to treat related problems like infection, pain, or swelling, and inherited gene differences are not known to play a major role in how these medicines work. In day-to-day care, things like age, allergies, other health conditions, and how severe the infection is usually matter more than genetics when doctors choose antibiotics or pain relief. Because treatment often depends more on the structure of the tract itself, many living with this condition need a procedure or surgery rather than relying on medication alone.
Pharmacological treatments
With a nasal dorsum fistula, medicines usually help control infection, drainage, or pain, but they do not remove the tract itself. In most cases, the lasting treatment is surgery, while drugs are used when the area becomes inflamed, infected, or sore. Starting a new prescription can bring questions, especially if there is redness, swelling, or discharge on the bridge of the nose. If you are wondering about antibiotics for infected nasal dorsum fistula, the choice depends on how mild or severe the infection is and whether surgery is planned soon.
Common first choices include amoxicillin-clavulanate, cephalexin, or clindamycin when the skin around the fistula looks infected or is draining pus. These medicines treat nearby soft-tissue infection, but they do not close the fistula itself. Doctors choose among them based on allergy history, local resistance patterns, and how severe the infection seems.
If there is concern for resistant bacteria, options such as trimethoprim-sulfamethoxazole or doxycycline may be used. Not everyone responds to the same medication in the same way, so the exact drug depends on age, pregnancy status, allergies, and local bacterial patterns. These are usually reserved for cases where standard antibiotics may not be enough.
More serious infection, spreading redness, fever, or an abscess may require hospital treatment with intravenous drugs such as cefazolin, ampicillin-sulbactam, clindamycin, or vancomycin. This is more likely if the infection is deep, rapidly worsening, or if surgery is being arranged urgently. Imaging and specialist review are often done at the same time because the tract can extend deeper than it appears on the skin.
Acetaminophen or ibuprofen may help with soreness, swelling, and tenderness around a nasal dorsum fistula. These medicines can make day-to-day comfort better while infection is being treated or while waiting for surgery. They do not treat the underlying tract, so ongoing drainage or repeated swelling still needs medical follow-up.
Genetic influences
When a baby is born with a tiny opening, dimple, or drainage spot on the bridge of the nose, families often wonder whether nasal dorsum fistula was inherited. It’s natural to ask whether family history plays a role. For families looking into the genetic causes of nasal dorsum fistula, the main point is that an isolated nasal dorsum fistula is usually not linked to a single known inherited gene and is more often related to how the tissues of the nose and nearby skull formed very early in development. Rarely, nasal dorsum fistula can appear with other differences in the face or skull as part of a broader genetic condition, and in those cases a genetics evaluation may be more useful. If several relatives have similar findings, or if the child has other birth differences, doctors may look more closely for an underlying genetic cause. For most people, though, nasal dorsum fistula seems to happen sporadically rather than follow a clear pattern through families.
Is Nasal dorsum fistula genetic?
Genetics do not seem to play a major role in nasal dorsum fistula. Most cases are thought to happen sporadically during early development, with no clear inherited pattern or common gene change identified.
Having a genetic risk is not necessarily a diagnosis
Genetic variants are a normal part of being human and are common throughout the general population. Most do not have a direct impact on health and simply reflect natural human differences. In many genes, carrying a variant associated with a condition points to a possible link rather than a certain diagnosis, especially when several genes and environmental factors are involved. In some cases, though, a single well-understood variant in a specific gene is enough to confirm a diagnosis.
Pharmacogenetics—how genetics influence drug effects
For many living with nasal dorsum fistula, treatment decisions are usually shaped more by the tract’s location, the risk of infection, and whether surgery is needed than by inherited gene differences. Genetics is only one factor, and for nasal dorsum fistula there is no standard pharmacogenetic test that predicts which antibiotic, pain medicine, or anesthetic will work best. That is because treatment for nasal dorsum fistula is often surgical, while medicines are mainly used for short-term needs such as infection control, anesthesia, and pain relief. Still, some inherited gene differences can affect how the body handles certain pain medicines and other drugs used around surgery, so doctors may adjust care based on past side effects, family history, and any known drug-gene results. In most cases, genetic testing for nasal dorsum fistula is not part of routine medication planning, but if it appears with other birth differences or in several family members, a genetics evaluation may help guide the broader care plan.
Interactions with other conditions
People with nasal dorsum fistula often deal less with the opening itself and more with problems that can happen around it, especially repeated skin infections. If the tract becomes blocked or irritated, it can lead to swelling, redness, drainage, or an abscess, and these episodes may be mistaken for acne, a cyst, or routine cellulitis. Certain diseases may overlap, meaning a nasal dorsum fistula can exist alongside a dermoid cyst under the skin, and in a small number of cases the tract may extend deeper toward the tissues around the brain. That is why doctors often check carefully for related sinus or skull-base problems before any procedure, since infection in a deeper tract can become more serious. For many living with nasal dorsum fistula, the main concern is not that it causes many other illnesses, but that it can raise the risk of recurrent local infection until it is properly evaluated and treated.
How genes can cause diseases
Humans have more than 20,000 genes, each carrying out one or a few specific functions in the body. One gene instructs the body to digest lactose from milk, another tells the body how to build strong bones and another prevents the body's cells from beginning to multiply uncontrollably and developing into cancer. As all of these genes combined are the building instructions for our body, a defect in one of these genes can have severe health consequences.
Through decades of genetic research, we know the genetic code of any healthy/functional human gene. We have also identified that in certain positions on a gene, some individuals may have a different genetic letter from the one you have. We call these hotspots "Genetic Variations" or "Variants" in short. In many cases, studies have been able to show that having the genetic letter "G" in the position makes you healthy, but having the letter "A" in the same position disrupts the gene function and causes a disease. Genopedia allows you to view these variants in genes and summarizes all that we know from scientific research, which genetic letters (Genotype) have good or bad consequences on your health or on your traits.
What other conditions can cause similar symptoms to Nasal dorsum fistula?
Problems most often confused with a nasal dorsum fistula include a dermoid cyst or dermoid sinus, which is a small lump or tiny tunnel present from birth on the bridge of the nose, and common skin problems such as an infected cyst, boil, or pimple that causes swelling and drainage. Doctors also think about rarer birth differences, such as tissue from inside the skull extending toward the nose, because these can look similar but need different treatment.
History
Throughout history, people have described small openings, dimples, or draining spots along the bridge of the nose in babies and children, even if they did not yet understand what caused them. Families may have noticed a tiny pit that leaked a little fluid now and then, or a bump on the nose that seemed to flare up with repeated swelling or infection. What we now call nasal dorsum fistula was first recognized through these visible, everyday signs rather than through lab testing or scans.
Early doctors often grouped these findings with other unusual growths or birth differences of the face, so the condition was not always described in a consistent way. Not every early description was complete, yet over time it became clear that some people had a narrow tract under the skin of the nose, sometimes reaching deeper than it appeared from the outside. This mattered because what looked like a minor skin problem could, in some cases, connect to tissues below the surface.
As medical science evolved, surgeons and pathologists began to separate nasal dorsum fistula from other midline nasal conditions and to describe it more accurately in medical reports. Better anesthesia and safer surgical techniques made treatment more reliable, and later, imaging tests helped doctors check how far the tract extended before surgery. That was an important step, because complete removal lowers the chance that the problem will come back.
In recent decades, awareness has grown that early symptoms of nasal dorsum fistula can be subtle, especially when there is only a tiny skin opening or occasional drainage. Modern care now focuses on spotting the condition early, looking carefully for any deeper extension, and planning treatment in a way that protects both health and appearance. Although the details of how doctors describe it have changed over time, the main lesson from its history is simple: a small mark on the bridge of the nose can deserve careful medical attention.