Complete Supernumerary Nostril with Accessory Alar Fistula Reconstructed via Alar Wedge Excision Type 2: A Case Report and Literature Review.

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.