Ann Dermatol.  2015 Dec;27(6):748-750. 10.5021/ad.2015.27.6.748.

A Novel Approach for Full-Thickness Defect of the Nasal Alar Rim: Primary Closure of the Defect and Reduction of the Contralateral Normal Ala for Symmetry

Affiliations
  • 1Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea. sj.jo@snu.ac.kr

Abstract

In full-thickness defects of the nasal alar rim, to achieve projection and maintain airway patency, cartilage graft is frequently needed. However, cartilage graft presents a challenge in considerations such as appropriate donor site, skeletal shape and size, and healing of the donor area. To avoid these demerits, we tried primary closure of alar rim defects by also making the contralateral normal ala smaller. We treated two patients who had a full-thickness nasal alar defect after tumor excision. Cartilage graft was considered for the reconstruction. However, their alar rims were overly curved and their nostril openings were large. To utilize their nasal shape, we did primary closure of the defect rather than cartilage graft, and then downsized the contralateral nasal ala by means of wedge resection to make the alae symmetric. Both patients were satisfied with their aesthetic results, which showed a smaller nostril and nearly straight alar rims. Moreover, functionally, there was no discomfort during breathing in both patients. We propose our idea as one of the reconstruction options for nasal alar defects. It is a simple and easy-to-perform procedure, in addition to enhancing the nasal contour. This method would be useful for patients with a large nostril and an overly curved alar rim.

Keyword

Acquired nose deformities; Nasal alar rim defect; Reconstructive surgical procedures

MeSH Terms

Cartilage
Humans
Nose Deformities, Acquired
Reconstructive Surgical Procedures
Respiration
Tissue Donors
Transplants

Figure

  • Fig. 1 (A) A 0.8-cm slightly erythematous papule was seen on the left nasal ala. An incision line was drawn on the normal ala similar to that in the involved ala (dotted line). (B) A full-thickness alar rim defect after mass excision was noted. (C) At the 2-week postoperative evaluation, reduction of both alae with minimally visible scars was observed.

  • Fig. 2 (A) Basal cell carcinoma was noted on the left nasal tip and ala. (B) A 1.5×2.0 cm alar rim defect after Mohs micrographic surgery was noted. (C) The alar rim defect was closed primarily, and then the remaining defect was reconstructed with concurrent reduction of the contralateral normal ala and the dorsal nasal flap. (D) At the 9-month visit, the postoperative scars were minimally visible.


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