title: Rhinoplasty: congenital deficiencies of the alar cartilage.
abstract: BACKGROUND
  Congenital deficiencies of the alar cartilages are rare and often visible at birth but can occasionally present later.
  
  
  OBJECTIVE
  The authors review the anatomical development and discuss the incidence and treatment of congenital defects within the alar cartilages seen in rhinoplasty cases.
  
  
  METHODS
  The charts of 869 consecutive patients who underwent open rhinoplasty were retrospectively reviewed, and 8 cases of congenital defects of the alar cartilage within the middle crura were identified. Intraoperative photographs were taken of the alar deformities, and each patient underwent surgical correction. To simplify analysis, a classification of the defects was developed. A division was a cleft in the continuity of the alar cartilage with the 2 ends separate. A gap was a true absence of cartilage ranging from 1 to 4 mm, which can be accurately assessed in unilateral cases. A segmental loss was a defect greater than 4 mm.
  
  
  RESULTS
  The 8 cases of deformity could be classified as 4 divisions, 3 gaps, and 1 segmental loss. None of the patients had a history of prior nasal trauma or nasal surgery. Six patients were women and 2 patients were men. In all cases, adequate projection and stability were achieved with a columellar strut. Asymmetry was minimized through concealer or tip grafts. There were no complications.
  
  
  CONCLUSIONS
  Surgeons performing rhinoplasty surgery will encounter and should be prepared to deal with unexpected congenital defects of the alar cartilage. These defects within the middle crura will require stabilization with a columellar strut and, often, coverage with a concealer tip graft. We speculate that the cause of these defects is a disruption of the hedgehog signals that may arrest the condensation or block the differentiation of the underlying neural crest cells.
authors.affiliation: Division of Plastic Surgery, School of Medicine, University of California-Irvine, CA, USA.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Kosins
authors.forename: Rollin K
authors.initials: RK
authors.lastname: Daniel
authors.forename: Ali
authors.initials: A
authors.lastname: Sajjadian
authors.forename: Jill
authors.initials: J
authors.lastname: Helms
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004954:Esthetics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055171:Nasal Cartilages / Q000002:abnormalities / Q000601:surgery*; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult
keywords: alar cartilage; congenital; domal notch; medial crura; nasal tip; projection; rhinoplasty