ADOLESCENT NASAL DEFORMITY FROM NEONATAL IATROGENIC TRAUMA: SURGICAL RESTORATION VIA FAT AND CARTILAGE GRAFTING: A CASE REPORT
DOI:
https://doi.org/10.53582/2n79s714Keywords:
Iatrogenic nasal deformity; Neonatal nasotracheal intubation injury; Agenesis of medial and lateral crus of lower lateral cartilage; Reconstruction with fat and cartilage graft; RhinoseptoplastyAbstract
Defects of the nasal complex can cause significant functional and psychosocial impairment whether acquired or congenitally inherited. Iatrogenic nasal deformities are uncommon complication of supportive care in neonates. Poor placement, insufficient immobilization of the cannula or prolongated nasopharyngeal intubation can result in injury to the nasal lining and can lead to aplasia of the nasal cartilage.
We present the case of a 17‑year‑old female who developed an iatrogenic nasal deformity following prolonged nasotracheal intubation as a premature neonate at seven months gestation, necessitating a three‑month NICU stay. On examination, right nostril asymmetry and breathing difficulties were noted. During open rhinoplasty, agenesis of the medial and lateral crura of the right lower lateral cartilage was discovered - an anatomical deficiency creating a significant reconstructive challenge.
Our surgical approach employed two stages: first, fat grafting to restore soft tissue volume and contour; second, autologous cartilage grafting from the septum (with options including conchal cartilage or dorsal hump cartilage) to reconstruct the undeveloped lower lateral cartilages. This method successfully restored nasal symmetry and improved airway function. The case underscores the importance of recognizing iatrogenic cartilage damage in patients with neonatal airway interventions and illustrates effective staged reconstructive strategies for such rare but impactful deformities.
References
1. Gowdar K, Bull MJ, Schreiner RL, Lemons JA, Gresham EL. Nasal deformities in neonates: Their occurrence in those treated with nasal continuous positive airway pressure and nasal endotracheal tubes. American Journal of Diseases of Children 1980; 134(10): 954-957. PMID: 6999890
2. Robinson B, Hilger P. Hereditary agenesis of nasal cartilage: surgical implications. Archives of Otolaryngology-Head & Neck Surgery 1989; 115(8): 985-988. doi: 10.1001/archotol.1989.01860320095026.
3. Gentile P, Cervelli V. Nasal tip remodeling using autologous cartilage grafts: A systematic review. Journal of Craniofacial Surgery 2022; 33(7): 2035-2040. doi: 10.1097/SCS. 0000000000008494.
4. Abbaszadeh A, Foroutan A, Sherafat A. Isolated congenital absence of right lower lateral cartilage and reconstruction with septal cartilage: A case report and review of literature. World J Plast Surg 2021; 10(2): 120-123. doi: 10.29252/wjps.10.2.120.
5. Soni K, Kaushal D, Choudhury B, Sahu RK. Bilateral congenital aplasia of nasal lower lateral cartilage: a rare anomaly. BMJ Case Rep 2020; 13(1): e231905. doi: 10.1136/bcr-2019-231905.
6. Zainy JH. Isolated congenital absence of lower lateral cartilages: A four cases report. JPRAS Open 2018; 18: 72-77. doi: 10.1016/j.jpra.2018.09.003.
7. Coban YK, Dogan A, Erbatur S. Isolated congenital hypoplasia of nasal lower lateral cartilages and its correction with helical rim and conchal cartilage composite grafts. Cleft Palate Craniofac J 2012; 49(4): e42-e45. doi: 10.1597/11-084.
8. Cerkes N. Nasal Tip Deficiency. ClinPlast Surg 2016; 43(1): 135-150. doi: 10.1016/j. cps.2015.09.011.
9. Klinger M, Maione L, Villani F, Caviggioli F, Forcellini D, Klinger F. Reconstruction of a full-thickness alar wound using an auricular conchal composite graft. Can J Plast Surg 2010;18(4):149-51. doi: 10.1177/229255031001800409.
10. Herbst M, Kaminski E, Swiatkowski T. Alar necrosis due to pilot tube erosion in a nasotracheally intubated infant: a case report. Middle East Journal of Anaesthesiology 2017; 25(2): 189-191.
11. Menick FJ. Anatomic reconstruction of the nasal tip cartilages in secondary and reconstructive rhinoplasty. Plastic and Reconstructive Surgery 1999; 104(7): 2187 2198. doi: 10.1097/00006534-199912000-00037.
12. Schultz Coulon HJ. Repair of postintubational lesions of the cartilaginous nose in infants – sometimes a surgical problem. Int J Pediatr Otorhinolaryngol 1984; 7(2): 119 131. doi: 10.1016/S0165 5876(84)80036 1.
13. Kawakita S, Jung DH, Sekino M, et al. Dorsal augmentation: A review of current graft options. Plastic and Reconstructive Surgery Global Open 2022; 10(8): e4510. PMCID: PMC9912050.
14. Temiz G, Yeşiloğlu N, Sarici M, Filinte GT. Congenital isolated aplasia of lower lateral cartilage and reconstruction using dorsal hump material. J Craniofac Surg 2014; 25(5): e411-e413. doi: 10.1097/SCS.0000000000000909.
15. Jayaratne YSN, Zwahlen RA, Htun SY, Bütow K W. Columella pressure necrosis: a method of surgical reconstruction and its long-term outcome. BMJ Case Reports 2014; 2014: bcr2013203132. doi: 10.1136/bcr 2013 203132.
16. Maruccia M, Fanelli B, Ruggieri M, Onesti MG. Necrosis of the columella associated with nasal continuous positive airway pressure in a preterm infant. Int Wound J. 2012; 11(3): 335-336. doi: 10.1111/j.1742-481X.2012.01121.x.
17. Robertson NJ, McCarthy LS, Hamilton PA, Moss AL. Nasal deformities resulting from flow driver continuous positive airway pressure. Arch Dis Child Fetal Neonatal Ed 1996; 75(3): F209-F212. doi: 10.1136/fn.75.3.f209.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Igor Peev, Renata Kocoska, Elizabeta Mirchevska Zjogovska
This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under CC BY 4.0 
