Voldemort deformity: nasolabial transposition technique for severe nasal inlet stenosis.

A 49-year-old healthy white male presented to our clinic with the chief complaint of nasal congestion on inhalation and dissatisfaction with the appearance of his nose. He stated that he had ‘‘Voldemort Deformity’’ due to his slit-like nostril appearance, mimicking the villain, Lord Voldemort, in the Harry Potter series. History revealed prior cocaine abuse in the distant past. Physical exam demonstrated the ala were collapsed entirely and difficult to open with a cotton tip applicator and nasal speculum due to both mucosal stenosis and alar skin contracture bilaterally. There was a subtotal nasal septal perforation. No masses were identified in the nasal cavity (Figure 1). Massachusetts Eye and Ear Infirmary Human Studies Committee deemed report exempt. Given profound degree of stenosis, with deficiencies of skin, cartilage, and mucosa, regional flap transposition with cartilage grafting was selected as the reconstructive strategy. Because of the need for tissue at the lateral alar regions and not the central tip, nasolabial flaps were selected over a forehead flap as the primary reconstructive approach. In the first stage of repair, the right-sided alar stenosis was addressed. An area for incision was marked along the border of the right ala to separate it from the scar tissue, and the incision was extended intranasally 2.0 cm (see Supplemental Figure S1 at http://otojournal.org). A musculocutaneous nasolabial flap, measuring 4.0 cm in length and 1.5 cm in width at its widest point, was elevated in the nasolabial crease, rotated, and partially deepithelialized. The majority of the flap was used to replace intranasal mucosa, and then the existing ala was raised and sutured to the flap, which was positioned between it and the facial skin (Figure 2). After a period of 4 weeks, the right-sided repair was examined. The nasolabial transposition flap widened the nasal aperture significantly, resulting in improved nasal breathing and appearance. Given positive results of the first stage, the left ala was similarly reconstructed using a nasolabial flap. Due to the lack of cartilage in the alar region and continued collapse on inspiration, a decision was made to proceed with the third stage repair. An open rhinoplasty approach was used to separate the dorsal skin and reconstructed intranasal lining where only remnants of the lateral