Does Full Transfixion Incision Decrease Tip Projection in Endonasal Septoplasty with Spreader Grafts?

Abstract

The classic teaching is that full transfixion incision decreases nasal tip projection by disrupting the attachment of the medial crura to the caudal septum. A significant decrease in tip projection after endonasal septoplasty with spreader grafts through a full transfixion incision has not been identified at our institution. A retrospective cohort study was performed at our institution. Inclusion criteria consisted of patients undergoing endonasal septoplasty with spreader graft placement and available preoperative and one-year postoperative photos. Patients who had undergone an open approach, cosmetic rhinoplasty, had intercartilaginous incisions, or other procedures to affect tip projection were excluded. A query identified 432 patients, of which 104 patients met inclusion criteria. Of these, 19 had pre and post-operative photographs and were included in the final analysis. Mirror software was utilized to analyze the pre and post-operative photos for tip projection using the Goode method. The change in tip projection was analyzed from both left and right profile photos. The left change in nasal tip projection (or delta) was -0.010 (95% CI -0.003, -0.017) and the right delta was -0.013 (95% CI -0.005, -0.020). In our pilot study of 19 patients, we did not find a clinically significant change in nasal tip projection when a full transfixion incision was used for the approach. In our experience, full transfixion incision is a safe and effective method for improving functional status in patients without causing a significant change in nasal tip projection.