Isolated Unilateral Nasal Ala Cleft: A Rare Case Report

Abstract

Craniofacial clefts other than cleft lip and palate are reported to occur in 1.4 to 4.9 per 100,000 live births. Isolated cleft of the nasal ala is very rare, accounting for about 0.7% of all facial clefts. Prenatal diagnosis plays a critical role in management and parental counseling. In this case report, we present the diagnosis of an isolated unilateral cleft of the right nasal ala identified during the routine mid-trimester anomaly scan and confirmed through postnatal follow-up. The goal is to educate fetal medicine specialists about this rare diagnosis and to prevent postbirth surprises.

 

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Keywords

counselling of parents - nasal ala cleft - prenatal diagnosis - reconstruction and grafting - routine mid trimester anomaly scan

Introduction

An isolated, unilateral nasal ala cleft is a congenital abnormality characterized by a cleft or split on one side of the nasal ala, the outer, mobile part of the nose. It is extremely rare, with only a few cases reported in medical literature. The prognosis is usually good. In most cases, the cleft does not lead to significant respiratory distress or other complications. However, surgical repair is needed after birth to improve the appearance of the nose. This surgery is typically performed between 6 and 12 months of age. Multidisciplinary care involving pediatricians, plastic surgeons, and orthodontists may be necessary for prenatal counseling and postnatal management. Surgical options include ala rim reconstruction, cartilage grafting, or nasal ala reconstruction with composite grafts. The child may also require speech therapy and psychological support.[1] [2]

An isolated unilateral nasal ala cleft in a fetus can be a challenging diagnosis. Ultrasonographers play a crucial role in diagnosing it. A thorough understanding of facial embryology is essential for accurate diagnosis. Clefts of the nasal ala occur during embryonic development, usually between the 4th and 7th weeks of gestation. They result from the incomplete fusion of the medial and lateral nasal prominences.

The malformations most commonly associated with ala clefting are those of orbital hypertelorism, broadening of the nasal root, and median facial clefting, anterior cranium bifidum.[3]

We present the case of a primigravida, 32 years old, a nonconsanguineous couple, presented at 21 weeks of gestation for a mid-trimester anomaly scan. No previous scans were available, and no other significant history was noted. Ultrasound (US) revealed a beak-like image of the fetal nose in the midsagittal view of the face ([Fig. 1]). The coronal view of the face demonstrated discontinuity in the right nasal ala, suggesting a cleft ([Fig. 2]). Three-dimensional (3D) surface rendering of the face showed a bulge above the right nostril and disfigurement of the nose, which was confirmed in the postnatal follow-up as a cleft of the nasal ala ([Fig. 3]).

Fig. 1 Midsagittal section of the face: The profile view of the face shows a beak-like picture of the nose.

Fig. 2 The reverse face view/flipped face view shows discontinuity in the right nasal ala, hinting toward its cleft.

Fig. 3 Comparison of a three-dimensional (3D) rendered image of the fetal face in anomaly scan showing bulge above the right nostril and disfigurement of the nose, which is confirmed in the postnatal follow-up picture.

A detailed ultrasonography covering all other views did not reveal any other abnormality. No other associated anomalies were detected in the fetus.

The utilization of US imaging in the diagnosis of fetal isolated unilateral nasal ala cleft is crucial.

Imaging provides valuable visual evidence of the deformities associated with the nasal ala cleft, aiding in its correct diagnosis. Prenatal diagnosis is crucial for appropriate counseling because it allows parents to make informed decisions regarding pregnancy management, potential treatment options, interventions, and specialized medical care after birth.

Suspicion of an isolated nasal ala cleft should be considered during routine fetal ultrasound when the following features are observed:

1. Abnormal nasal beaking with a downward-pointing nasal tip.

2. Intact soft palate, hard palate, upper lip, and lower lip.

3. Absence of other facial anomalies, except for a unilateral discontinuity of the nasal ala seen in the coronal view of the face.

4. Routine anomaly scan should be extended to include 3D surface-rendered images of the fetal face for further evaluation.

 

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Conclusion

The isolated nasal ala cleft is an exceptionally rare and complex diagnosis in a fetal context. The chances of missing or overlooking this condition are significantly high due to its subtle two-dimensional imaging findings. We hope this case report raises awareness of this condition among sonographers and reaffirms the famous saying, “What the mind does not know, the eyes cannot see.”

 

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Conflict of Interest

None declared.

Authors' Contributions

1. Substantial contributions to conception and design, acquisition of data: R.V.S.

2. Drafting of the article, revising it critically for important intellectual content: R.S.D.

• References

• 1 Jinka JR, Chekuri H, Annavarapu G. Isolated cleft of the ala nasi: a report of seven cases. Indian J Plast Surg 2012; 45 (03) 512-515
• 2 Newman MH, Burdi AR. Congenital alar field defects: clinical and embryological observations. Cleft Palate J 1981; 18 (03) 188-192
• 3 Smith G, Wilson L. Cleft of The Nasal Ala: case report. Cleft Palate J 1976; 13: 74-75 . PMID: 1060530

Publikationsverlauf

Artikel online veröffentlicht:
08. Oktober 2025