Complete Supernumerary Nostril with Accessory Alar Fistula Reconstructed via Alar Wedge Excision Type 2: A Case Report and Literature Review
- 1Otorhinolaryngology-Head and Neck Surgery, Universitas Brawijaya, Indonesia
Abstract
Background: Supernumerary nostril with an accessory nasal fistula is an exceptionally rare congenital anomaly with no standardised reconstructive protocol, especially with nasolacrimal involvement.
Case report: A nine-year-old boy presented with a complete supernumerary nostril and synchronous accessory nasal fistula at the right alar base, persistent epiphora and prior endoscopic dacryocystorhinostomy. Imaging demonstrated a cystic tract communicating with the nasolacrimal system. Definitive management utilised a modified alar wedge excision type 2, incorporating both orifices into a single reconstructive unit. Three-month follow up demonstrated excellent aesthetic and functional outcomes with minimal scarring.
Literature review: A review of 12 previously published cases (2001–2025) revealed heterogeneous, largely non-standardised techniques, often relying on simple excision that may not correct alar asymmetry.
Conclusion: Complete tract eradication and restoration of alar symmetry were achieved. Alar wedge excision type 2 offers a reproducible technique for complex supernumerary nostril–accessory nasal fistula anomalies, particularly in Asian patients where tension-free closure minimises hypertrophic scarring.
Related
- Granulomatous lobular mastitis involving accessory breast tissue: a case report and review of the literature
- Probe-Guided Core Excision for Complete Sinus Tract Removal in Pilonidal Disease.
- Mesenteric vascular variations and Henle’s trunk anatomy in right colon cancer surgery: implications for complete mesocolic excision and D2 lymphadenectomy
- Rapidly Progressive Buschke-Löwenstein Tumor Managed With Wide Local Excision and Healing by Secondary Intention: A Case Report and Literature Review.
- Drug name confusion errors in the published literature and the USP Medication Errors Reporting Program, 1965-2004: a reconstructed dataset of 724 confused drug name pairs
BibTeX
@article{handoko2026complete,
title = {{Complete Supernumerary Nostril with Accessory Alar Fistula Reconstructed via Alar Wedge Excision Type 2: A Case Report and Literature Review}},
author = {Rizki Ekaputra Handoko and Iriana Maharani and Melody Audria Kurniadi},
journal = {The Journal of Laryngology and Otology},
year = {2026},
month = oct,
doi = {10.1017/s0022215126104824},
url = {https://doi.org/10.1017/s0022215126104824},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Complete Supernumerary Nostril with Accessory Alar Fistula Reconstructed via Alar Wedge Excision Type 2: A Case Report and Literature Review
AU - Rizki Ekaputra Handoko
AU - Iriana Maharani
AU - Melody Audria Kurniadi
PY - 2026
DA - 2026/10/30
JO - The Journal of Laryngology and Otology
DO - 10.1017/s0022215126104824
UR - https://doi.org/10.1017/s0022215126104824
AB - Background: Supernumerary nostril with an accessory nasal fistula is an exceptionally rare congenital anomaly with no standardised reconstructive protocol, especially with nasolacrimal involvement. Case report: A nine-year-old boy presented with a complete supernumerary nostril and synchronous accessory nasal fistula at the right alar base, persistent epiphora and prior endoscopic dacryocystorhinostomy. Imaging demonstrated a cystic tract communicating with the nasolacrimal system. Definitive management utilised a modified alar wedge excision type 2, incorporating both orifices into a single reconstructive unit. Three-month follow up demonstrated excellent aesthetic and functional outcomes with minimal scarring. Literature review: A review of 12 previously published cases (2001–2025) revealed heterogeneous, largely non-standardised techniques, often relying on simple excision that may not correct alar asymmetry. Conclusion: Complete tract eradication and restoration of alar symmetry were achieved. Alar wedge excision type 2 offers a reproducible technique for complex supernumerary nostril–accessory nasal fistula anomalies, particularly in Asian patients where tension-free closure minimises hypertrophic scarring.
SN - 0022-2151
SN - 1748-5460
ER -