Rhinoplasty: congenital deficiencies of the alar cartilage

Kosins AM, Daniel RK, Sajjadian A, Helms J.

What this paper says

Among 869 consecutive open rhinoplasties, 8 patients had a birth defect in the middle segment of the tip cartilage, classified as 4 clefts, 3 gaps of 1 to 4 mm and 1 loss over 4 mm, all corrected with a columellar strut and often a concealing tip graft, with no complications.

Overview

The tip cartilages occasionally have a gap or split present from birth that the surgeon discovers only when the nose is opened. The authors searched a large series for these defects, classified them by size, describe how they were corrected and propose a developmental cause.

Sections of note

Retrospective review of 869 consecutive open rhinoplasties; 8 congenital alar cartilage defects found, all in the middle crura.
Classification: division, a cleft with the two ends separate; gap, true absence of 1 to 4 mm; segmental loss, a defect over 4 mm.
Findings: 4 divisions, 3 gaps, 1 segmental loss; 6 women, 2 men; no prior trauma or surgery.
Treatment: columellar strut for projection and stability in all; concealer or tip grafts to minimize asymmetry.
No complications.
Proposed cause: disruption of hedgehog signaling affecting neural crest cells during development.

What it means for a patient

About 1 in 100 rhinoplasty patients in this series had a hidden gap in the tip cartilage that the surgeon had to handle unplanned.
The fix used standard grafts and did not cause problems in these 8 cases.
The developmental explanation is the authors' speculation, and 8 cases are too few to give reliable rates.

Why this paper matters

It names and classifies a finding that surgeons meet unexpectedly and gives a repair approach. Follow-up length and long-term stability of the repairs are not reported in the abstract.

Terms

Alar cartilages: the paired tip cartilages that shape the tip and nostrils; also called lower lateral cartilages.
Middle crus: the segment of the tip cartilage between the columella and the nostril.
Columellar strut: a cartilage rod placed between the tip cartilages to support and stabilize the tip.
Concealer graft: a thin cartilage piece placed over a defect to hide it.
Neural crest cells: embryonic cells that form much of the facial cartilage and bone.
Hedgehog signaling: a chemical pathway that directs tissue formation in the embryo.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“Congenital deficiencies of the alar cartilages are rare and often visible at birth but can occasionally present later. Objectives: 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…”

Excerpt; the full abstract is on PubMed.