Surgical reconstruction of the external nose: Alar rotational and hinged flap techniques for facial cleft Tessier 0-1 with lipoma on dorsal nasal region - A case report

Abstract

Introduction and importance: Tessier Craniofacial Clefts Numbers 0 and 1 represent unique facial deformities, with Number 0 involving midline structure hypoplasia and Number 1 exhibiting features like a notched soft triangle and affected alar dome. These anomalies can extend near the midline, leading to complications like telecanthus, necessitating innovative surgical strategies for reconstruction.

Case presentation: A five-month-old girl presented with Tessier 0 and 1 clefts and a dorsal nasal lipoma, challenging traditional repair methods due to structural limitations. This case required a comprehensive approach, including aesthetic excision of the lipoma and reconstruction of both the internal and external aspects of the nose.

Clinical discussion: The patient underwent successful nasal reconstruction using a transpositional alar flap with a pedicle from the angular artery and a hinge flap for the inner lining. The procedure involved cranial dissection through the flap incision for lipoma excision. This case highlights the complexity of nasal reconstruction in the presence of facial clefts and demonstrates the effectiveness of the alar transpositional flap as a viable technique for achieving aesthetically pleasing outcomes.

Conclusion: The case underscores the necessity for precise surgical planning and execution to address both cosmetic and functional aspects of nasal defects in facial cleft patients.

Keywords: Alar transpositional flap; Case report; Cleft nose; Facial cleft; Hinge flap; Tessier.