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• W4320801110 abstract "INTRODUCTION: The external nasal valve (ENV) represents the initial area of airway resistance of the nose. When this area is excessively narrow or lacks support, a patient can develop nasal obstruction leading to a decreased quality of life. While composite grafts may be used to support the lateral wall, repositioning a stenotic naris can be challenging. Weir incisions are a well-described technique used to move flared nostrils inward. However, moving medially displaced nostrils laterally is less commonly described. This case report describes a patient with ENV collapse and alar base malposition resulting in significant airway obstruction. Our surgical team developed a novel inferiorly-based alar base flap to achieve lateral movement of the displaced naris. CASE PRESENTATION: An 18-year-old woman with a history of previously repaired right-sided cleft lip/palate and cleft nasal deformity presented to our clinic complaining of continued right-sided nasal obstruction and asymmetry. She had previously undergone multiple operations, including open rhinoplasty with rib cartilage grafts by another surgeon. On examination, the patient had four problems that warranted correction: right internal nasal valve collapse, right ENV collapse, right-sided alar base/ nostril asymmetry, and nasal tip deformity. We discussed with the patient that all four problems could not be addressed in a single procedure. Correcting the internal nasal valve collapse and tip aesthetics would require a repeat open rhinoplasty, while fixing the ENV collapse and alar base/nostril asymmetry would require an operation on the external naris. However, performing both procedures at the same time would be risky due to concern for vascular compromise to the tissues. The patient was most bothered by her right-sided ENV collapse and alar base/nostril asymmetry and chose to have these corrected first. Our operative goal was to open up the right nostril by supporting the ala with a cartilage graft and repositioning the ala laterally. Previously described techniques for alar base repositioning in stenotic nostrils use flaps with superiorly-based pedicles perfused by the lateral nasal arteries. Due to the degree of movement and repositioning of the alar base, we determined that an inferiorly based flap would work better. Therefore, our team designed an alar base flap with an inferiorly-based pedicle to suit our patient’s needs. RESULTS: Postoperatively the patient had improvement in her ENV collapse and nasal obstruction and was happy with her results. She did not have any complications following the operation. CONCLUSION: This novel, inferiorly-based alar base flap is a useful alternative for alar base repositioning in the setting of a severely medially displaced alar base." @default.
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• W4320801110 date "2021-10-01" @default.
• W4320801110 modified "2023-10-16" @default.
• W4320801110 title "Cleft Rhinoplasty: A Novel Flap for Correcting Alar Base Malposition" @default.
• W4320801110 doi "https://doi.org/10.1097/01.gox.0000799884.16498.4c" @default.
• W4320801110 hasPublicationYear "2021" @default.
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