Surgical Management of a Rare Alar Cleft: A Case Report
Abstract
Alar cleft is a rare congenital nasal deformity affecting the nasal ala. It can be associated with craniofacial syndromes or isolated anomalies. Isolated congenital alar clefts are exceptionally uncommon, and only limited cases have been reported in the literature, making this condition a significant reconstructive challenge in pediatric patients. There are no criteria guiding the correction of congenital alar anomalies; therefore, surgical corrections might be challenging. A 3-month-old infant presented with an uncommon congenital alar cleft, leading to aesthetic concerns. We performed a surgical procedure by dividing the anterior and posterior flaps, trimming them, and connecting them with the nasal alar skin. This surgical technique is clinically important because it preserves native tissue, provides good vascularity and tissue alignment, minimizes visible scarring, and avoids the need for more complex grafting procedures. Postoperative follow-up showed significant improvement in nasal contour and symmetry; no complications such as wound dehiscence were reported. Various surgical techniques have been described for alar cleft repair. The choice of technique depends on the size and location of the defect, and surgeon experience. The chosen technique ensures good tissue alignment with minimal scarring. There are no specific techniques for repairing alar clefts. The goal of surgery is to achieve normal-like results. Early surgical intervention yields better outcomes, especially in psychological issues. This case also highlights the broader importance of individualized planning in pediatric reconstructive surgery, particularly in preserving facial growth, achieving long-term aesthetic outcomes, and improving quality of life in children with rare craniofacial anomalies.
Downloads
References
Agrawal, K. S., Shende, N. K., Khare, N., & Deshpande, O. N. (2014). A novel technique for correction of congenital cleft of ala. Journal of Cleft Lip Palate and Craniofacial Anomalies, 1(2), 119–121. https://doi.org/10.4103/2348-2125.137913
Akintoye, S. O., Adisa, A. O., Okwuosa, C. U., & Mupparapu, M. (2024). Craniofacial disorders and dysplasias: Molecular, clinical, and management perspectives. Bone Reports, 20, 101747. https://doi.org/https://doi.org/10.1016/j.bonr.2024.101747
Austin, G. K., Shockley, W. W., Surgery, N., & Hill, C. (2017). Reconstruction of Nasal Defects : Contemporary Approaches. 1–16. https://doi.org/10.1097/MOO.0000000000000295.Reconstruction
Baker, S. R. (2014). Local Flaps in Facial Reconstruction (Elsevier Health Sciences (ed.); 3rd ed.). Elsevier Health Sciences.
Boccieri, A., & Marano, A. (2007). The conchal cartilage graft in nasal. Journal of Plastic, Reconstructive & Aesthetic Surgery, 60, 188–194. https://doi.org/10.1016/j.bjps.2006.02.005
Cerci, F. B. (2017). Usefulness of the subunit principle in nasal reconstruction. Anais Brasileiros de Dermatologia, 92(Figure 3), 159–162.
Chapchay, K., Zaga, J., Billig, A., Adler, N., & Margulis, A. (2019). Surgical Technique for Nasal Cleft Repair. Annals of Plastic Surgery, 82(3), 289–291. https://doi.org/10.1097/SAP.0000000000001688
Cielo, C. M., Montalva, F. M., Taylor, J. A., Pedregal, A., Contreras, M., & Surgery, R. (2017). Craniofacial disorders associated with airway obstruction in the neonate. HHS Public Access, 21(4), 254–262. https://doi.org/10.1016/j.siny.2016.03.001.Craniofacial
Deftereou, T., Karapepera, V., Lialiaris, S., & Fotiadis, G. (2025). Congenital Anomalies of the Nose : From Embryologic to Surgical Treatment. Cureus, 17(8). https://doi.org/10.7759/cureus.89397
Farahani, P. K. (2024). Application of Tissue Engineering and Biomaterials in Nose Surgery. Els, 40, 262–272. https://doi.org/10.1016/j.jpra.2023.11.001
Gasteratos, K. (2020). Microvascular Reconstruction of Complex Nasal Defects : Case Reports and Review of the Literature. PRS Global Open, 1–9. https://doi.org/10.1097/GOX.0000000000003003
Hom, D. B. (2024). Reducing Risks for Local Skin Flap Failure. HHS Public Access, 31(2), 1–23. https://doi.org/10.1016/j.fsc.2023.01.006.Reducing
I, A. G., Franco, S., Gonçalves, H., Coelho, F., Ramos, F., & Moura, P. (2023). PREVALENCE AND CHARACTERISTICS OF FETAL CRANIOFACIAL ANOMALIES IN A 15-YEAR TIMELINE : Insights from Prenatal Ultrasound Evaluation. 26(6), 37565090. https://doi.org/10.14366/usg.18031.
Kannan, R., John, R., & Elangovan, R. (2012). Isolated cleft of alar rim. Annals of Maxillofacial Surgery, 2(1), 60–62. https://doi.org/10.4103/2231-0746.95323
Klassen, A. F., Phil, D., Cano, S. J., Ph, D., Scott, A., Snell, L., & Pusic, A. L. (2010). Measuring Patient-Reported Outcomes in Facial Aesthetic Patients : Development of the FACE-Q. 1(212), 303–309.
Losee, J. E., Kirschner, R. E., Whitaker, L. A., & Bartlett, S. P. (2003). Congenital Nasal Anomalies : A Classification Scheme. American Society of Plastic Surgeons, 676–689. https://doi.org/10.1097/01.PRS.0000101540.32533.EC
Mariana, R., Viviana, G., Cardona, C., & Hoz-valle, J. A. De. (2023). Hyperbaric Oxygen Therapy in Plastic , Aesthetic , and Reconstructive Surgery : Systematic Review. Surgical Techniques Development, 12(1), 43–52. https://doi.org/https://doi.org/10.3390/std12010003
Marsden, N. J., Kyle, A., Jessop, Z. M., Whitaker, I. S., & Laing, H. (2015). Long-term outcomes of microsurgical nasal replantation : review of the literature and illustrated 10-year follow-up of a pediatric case with full sensory recovery. Frontiers in Surgery, 2(February). https://doi.org/10.3389/fsurg.2015.00006
Marta, D., Francy, R., Pranidhi, B., & Daniel, B. (2021). Craniofacial Development : Neural Crest in Molecular Embryology. Head and Neck Pathology, 15(1), 1–15. https://doi.org/10.1007/s12105-021-01301-z
Menick, F. J. (2008). Nasal Reconstruction: Art and Practice. Elsevier Health Sciences UK.
Monstrey, S., Middelkoop, E., Jeroen, J., Bassetto, F., Ziegler, U. E., & Meaume, S. (2014). Updated Scar Management Practical Guidelines : Non-invasive and invasive measures. Journal of Plastic, Reconstructive & Aesthetic Surgery, 67, 1017–1025. https://doi.org/10.1016/j.bjps.2014.04.011
Potter, J. K. (2003). Nasal Reconstruction — Beyond Aesthetic Subunits : A 15-Year Review of 1334 Cases. 1405–1416. https://doi.org/10.1097/01.PRS.0000138596.57393.05
Ramanathan, M., Sneha, P., & Sailer, H. F. (2014). Reconstruction of Nasal Cleft Deformities Using Expanded Forehead Flaps : A Case Series. 13(4), 568–574. https://doi.org/10.1007/s12663-013-0549-9
Rhee, J. S., Weaver, E. M., Park, S. S., Baker, S. R., Hilger, P. A., Kriet, J. D., Murakami, C., Senior, B. A., Rosenfeld, R. M., & Divittorio, D. (2010). Clinical consensus statement : Diagnosis and management of nasal valve compromise. YMHN, 143(1), 48–59. https://doi.org/10.1016/j.otohns.2010.04.019
Srikanthan, A., Scott, S., Desai, V., & Reichert, L. (2022). Neonatal Airway Abnormalities. MDPI Children, 9(944), 1–17.
Velarde, K., Cafino, R., Jr, A. I., Ty, K. M., Potter, L., Nadorra, L., Pueblos, L. V., Clark, L., Velarde, K., Cafino, R., Jr, A. I., Ty, K. M., Potter, L., Nadorra, L., Pueblos, L. V., & Velasco, L. C. (2023). Virtual surgical planning in craniomaxillofacial surgery : a structured review. Computer Assisted Surgery, 28(1). https://doi.org/10.1080/24699322.2023.2271160
Williamson, L., Close, M., Kappauf, C., & Patel, K. (2025). Congenital nasal deformities : advances in early. https://doi.org/10.20517/2347-9264.2025.70
Yu, B., Duan, R., Chen, X., He, J., Xie, F., Dai, C., & Wei, J. (2025). Asymmetric Z-plasty for correction of iatrogenic nostril “ Q ” deformities in Asian patients. Asian Journal of Surgery, 48(1), 419–423. https://doi.org/10.1016/j.asjsur.2024.10.064
Copyright (c) 2026 Damar Dita Kirana, Indri Lakhsmi Putri, Mirnasari Amirsyah
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
