Isolated Congenital Partial Absence of the Lateral Crural Cartilage

Dr. Süleyman Taş reports a rare congenital partial absence of the left lateral crural cartilage in a 22-year-old woman and describes reconstruction with a lateral crural strut graft and rim graft.

A Rare Congenital Nasal Anomaly

Congenital anomalies of the nose are uncommon, with the supplied publication citing an estimated incidence of approximately 1 in 20,000 to 1 in 40,000. Many congenital nasal anomalies occur as part of syndromes or familial conditions, while isolated nonsyndromic absence of an individual nasal cartilage is especially rare.

This correspondence by Dr. Süleyman Taş presents an isolated, nonsyndromic and nonfamilial partial absence of the left lateral crural cartilage (LCC). The report explains that only a small number of isolated lateral-crural aplasia or hypoplasia cases had previously been described.

Clinical Presentation

A 22-year-old woman presented with nasal airway obstruction and a visible nasal-shape deformity. She had no history of nasal trauma, previous nasal surgery, reduced smell or epistaxis.

Examination showed a dorsal hump, external deviation to the left, mild septal deviation to the right, pronounced nostril asymmetry and a notch in the left alar region. During the Cottle-type assessment described in the report, the left side collapsed completely, indicating external nasal-valve insufficiency.

Intraoperative Finding

A closed septorhinoplasty was performed. After hump treatment and septal correction, the lower lateral cartilages were exposed using a delivery technique. A defect measuring approximately 2 × 1 cm was identified in the left lateral crural cartilage about 1 cm lateral to the left dome.

The finding explained the visible alar notch, nostril asymmetry and weakness of the external valve. Because the patient had no history of surgery or trauma, the defect was interpreted as a congenital structural anomaly.

Reconstruction

The missing segment was reconstructed with a lateral crural strut graft. An additional rim graft was placed to reinforce the external valve and alar margin. Interdomal and intradomal sutures were used to improve tip and nostril symmetry.

Tip support was further reinforced with a medial deep SMAS layer suture, a technique previously described by the author. The operation was completed without reported intraoperative complication.

Outcome

At 12 months, the publication reports a satisfactory functional and aesthetic result. The reconstructed lateral wall supported the external nasal valve and improved the contour abnormality associated with the congenital defect.

Embryology and Classification

The lateral crura and external nasal walls develop from paired lateral nasal processes during early gestation. The paper notes that local pressure or a vascular developmental event has been proposed as a possible explanation for isolated defects, although the exact cause in this patient cannot be proven.

The correspondence discusses an existing classification of congenital nasal anomalies that includes hypoplasia or aplasia, hyperplasia or duplication, atypical clefts and neoplastic or vascular anomalies. The author argues that partial absence does not fit perfectly within the existing categories and that classification systems may need refinement as additional rare cases are described.

Clinical Lesson for Rhinoplasty Surgeons

A mild external contour defect can occasionally represent a substantial underlying congenital cartilage anomaly. Surgeons should therefore be prepared for unexpected structural findings even when there is no trauma or previous operation. Current cartilage-grafting methods can provide options for reconstructing these rare defects.

Source Note

The uploaded PDF page contained several neighboring correspondence articles from the same journal issue. Only the section titled “Isolated Congenital Partial Absence of the Lateral Crural Cartilage,” authored by Süleyman Taş, was used for this Dr. Süleyman Taş blog entry. The unrelated nasal-myiasis and blepharoplasty correspondence appearing on adjacent parts of the supplied pages were not attributed to Dr. Taş.

Official Publication and External Source

Journal website: https://journals.lww.com/jcraniofacialsurgery/

Journal: The Journal of Craniofacial Surgery. This page is a comprehensive educational presentation derived from the supplied scientific publication and does not replace individualized medical evaluation.