Background: Nasal alar deformity (NAD) can affect both nasal breathing and the aesthetic appearance of the nose. NAD can be congenital or acquired. The acquired causes include nerve palsies, traumatic or iatrogenic. A rare condition that is associated with NAD is trigeminal trophic syndrome (TTS). TTS is an uncommon disorder of the trigeminal nerve characterized by a triad of facial ulcers, with anesthesia and paresthesia of the involved dermatomes. Nasal alar reconstruction is challenging for the surgeon and when it is performed, a delicate balance between aesthetic and functional outcome should be considered. Case report: A 37 years old woman presented with nasal alar deformity caused by facial and trigeminal nerve paralysis after brain surgery. The woman was diagnosed with an acoustic neuroma and underwent complete tumor removal from neurosurgeons. After surgery, the patient suffered from facial and trigeminal nerve paralysis and 4-years later she presented with a progressive nasal alar deformity accompanied by breathing and aesthetic dysfunction. Reconstruction of the nasal ala was performed in one-stage surgery using spreader, alar batten and rim grafts. Seven years postoperatively, our patient had good nasal breathing and did not show any alar collapse. Conclusions: In our case we believe that facial and trigeminal nerve palsies as a result of brain surgery, have both contributed to the deformity of the nasal ala. Reconstruction with the optimal technique and graft guaranteed long term results.

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