Modified Z‐Plasty of the Ala to Relieve Nasal Vestibular Stenosis

Abstract

Objectives: Nasal vestibular stenosis results in significant functional impairment and cosmetic deformity. Various techniques can be used, including excision of the deformed segment and replacement with healthy tissue using local flaps, composite or cartilage grafts, with or without stents. W-plasty, Z-plasty, and double-cross plasty techniques have also been described. We aimed to evaluate the following outcome measures: 1) Describe our modified Z-plasty technique to widen the ala base. 2) Report patient satisfaction with respect to functional and cosmetic improvement. Methods: A retrospective study over a 4-year period was conducted on patients who underwent modified Z-plasty of the ala. This is performed under general anaesthetic, with infiltration of 2% lignocaine, and 1:80,000 adrenaline to the lateral alar margin and adjacent soft tissue, overlying the piriform aperture margin. A Z-plasty incision is made around the lateral ala and anterior nasal process of maxilla. The two triangular flaps are transposed to lateralize the ala and widen the vestibule. Results: Six patients have undergone modified Z-plasty of the ala, including 5 females and 1 male, with a mean age of 40 +/-13.5years. All patients presented with narrowing of the vestibule from scarring of the ala, secondary to burn, blast, and traumatic injuries. All patients confirmed significant improvement in their nasal breathing. There were no post-operative complications. Conclusions: Nasal vestibular stenosis is a challenging deformity, with a variety of potential surgical approaches. We describe our modified Z-plasty of the ala, which we have used in 6 patients, all of whom have reported both functional and cosmetic improvement.