Quiz 4: Eight year old boy without a nose

Below is a picture of an eight year old boy I saw in India in 2006. He had gradually progressed to this condition over a period of many months. He was breathing on his own and indicating hunger and other needs when seen. He did not give history of fever or trauma. His vital signs were normal except that his systolic BP was over the 95th percentile. His chest and abdomen exams were normal.

Question: What is the diagnosis?