Isolated congenital absence of the left lower lateral cartilage.

Introduction: Congenital defects of the nasal cartilaginous skeleton are rare, yet clinically relevant, entities that are important to recognize prior to operative repair Methods: A 47 year old woman was referred to our institution for lifelong leftsided nasal airway obstruction. On physical examination, a complete absence of the left lower lateral cartilage was suspected. Hypothesis: Complete congenital absence of the lower lateral cartilage Results: External approach rhinoplasty confirmed the above hypothesis, and reconstruction was performed with autologous septal cartilage. Conclusions: Careful history and physical examination is important in preoperative planning of nasal surgery. External rhinoplasty approach Isolated complete absence of left lower lateral cartilage identified (Figure 2a) Septal cartilage harvested Septal extension graft replaced the left medial crura Lateral crural strut graft replaced the left lateral crura Shield graft to orient and help reconstitute the tip Left domal onlay graft to emphasize left tip highlight Patient pleased with functional and aesthetic outcome Surgical Approach and Results 1. Losee JE, Kirschner RE, Whitaker LA, et al. Congenital nasal anomalies:a classification scheme. Plast Reconstr Surg 2004;113:676-689.2. Bilkay U, Tokat C, Ozek C. Reconstruction of congenital absentcolumella. J Craniofac Surg 2004;15(1): 60-63.3. Mavili ME, Akyurek M. Congenital isolated absence of the nasalcolumella: reconstruction with an internal nasal vestibular skin flap andbilateral labial mucosa flaps. Plast Reconstr Surg 2000;106(2):393 -399.4. Yilmaz MD, Altunas A. Congenital vomeral bone defect. Am JOtolaryngol 2005;26(1):64-66.5. Klinger M. Caviggioli, Klinger F, et al. Isolated congenital absence of thenasal bones and aesthetic surgical correction: managing and casereport. Aesth Plast Surg 2005;29(4):246-249.References 47 year old otherwise healthy Latin American femaleLifelong left sided nasal airway obstructionNo prior facial trauma or surgeryExam showed mild septal deviation, profound nostrilasymmetry, and the absence of any palpablecartilage within left side of the nasal tip (Figure 1)Case PresentationFigure 2a. Complete absence oflower lateral cartilage on the left.Figure 2b. Surgical repair withseptal extension, lateral cruralstrut, and domal onlay grafts. Isolated, non-syndromic cases of absent nasalstructures is exceedingly rare.No previous reports exist of isolated absence of alower lateral cartilage.May occur after fusion of mesenchymal componentsby 10th week of gestation from vascular accident orpressure phenomenon.Despite its rarity, this anomaly reinforces theimportance of careful pre-rhinoplasty analysis andfamiliarity with principles of open structurerhinoplasty.ConclusionsIntroduction History and physical examination are crucial toappropriate pre-operative planning of functional andcosmetic rhinoplastyExternally, special attention is paid to thecharacteristics of the skin-soft tissue envelope, thenasal bones, middle nasal vault, and the lowerlateral cartilages.Internally, examination of the septum, the internaland external nasal valves, nasal sidewalls, inferiorturbinates and the nasal mucosa.Congenital anomalies of the nose can beresponsible for nasal airway obstruction and arepresent in 1/20,000 to 1/40,000 births Figure 1.Asymmetry of external nose noted with basal and frontal views.