Layered Reconstruction of Full-Thickness Alar Deficiency in Tessier 1 Nasal Clefts: A 2-Case Technical Note

Abstract

Objective

To describe a layered reconstructive technique for full-thickness alar deficiency in unilateral Tessier 1 nasal clefts.

Design

Technical note illustrated by a 2-case series with medium-term follow-up.

Setting

Single tertiary academic plastic and craniofacial surgery center.

Patients, Participants

Two pediatric patients aged 2 and 4 years with unilateral Tessier 1 alar clefts demonstrating full-thickness deficiency of lining, structural support, and external cover.

Interventions

Layered reconstruction using a hinged cutaneous lining flap, auricular cartilage graft support, and dorsal nasal transposition flap for external cover.

Main Outcome Measure(s)

Clinical contour stability, nostril patency, scar quality, need for revision, and caregiver-reported satisfaction.

Results

At 3 and 3.5 years follow-up, both patients demonstrated stable alar contour, maintained nostril patency, no collapse or notching, and no secondary revisions.

Conclusions

The described layered technique provides a feasible reconstructive option for selected Tessier 1 alar clefts with full-thickness deficiency and demonstrated encouraging medium-term stability.