Columellar Strut Research Articles

Augmentation Rhinoplasty in Cleft Lip Nasal Deformity Using Alloplastic Material and Autologous Cartilage.

Secondary cleft rhinoplasty typically requires large amounts of cartilage grafts for augmentation. The purpose of this study was to present our short-term experience with alloplastic implants in cleft rhinoplasty. This was a retrospective cohort study of cleft lip and palate patients treated with secondary rhinoplasty at Hanoi Medical University Hospital and Ruby Hospital between 2017 and 2020. All rhinoplasty procedures consisted of lower lateral cartilage repositioning, a dorsal augmentation with silicone implant, columellar strut implant or graft, and onlay tip grafts. Cartilage was obtained from the septum and concha, and no cartilage was harvested from the rib. The study outcomes included the Rhinoplasty Outcome Evaluation (ROE) survey, a modified Mortier scoring scale, 8 intranasal measures of symmetry, and 4 nasofacial measures of tip projection and nasal length. Changes in patient satisfaction and nasal esthetics were compared before and after surgery. A total of 38 patients were included in the final study sample, of whom 65.79% had unilateral clefts. The overall complication rate was 7.89%, and there were 2 cases of infection and 1 case of dorsal implant displacement. Following rhinoplasty, ROE satisfaction scores significantly increased (+39.36, P <0.01) and Mortier severity scores decreased (-3.06, P <0.01). Nostril symmetry nearly normalized in width, height, and inclination. Mean columellar deviation decreased from 8.82 to 2.08 degrees, and nasal projection increased as assessed on multiple analyses. Patients with bilateral clefts had similar improvements in ROE and Mortier scores. In our experience, synthetic implants simplified the correction of cleft nasal deformity and eliminated the need for costal cartilage. We found that our protocol produced acceptable and stable short-term clinical results without increasing the complication rate above what has been reported with autologous grafts.

Reorienting Lower Lateral Cartilages With Lateral Crural Struts: Aesthetic and Functional Benefits

Nasal tip shape and position play a major role in the aesthetic appearance of the nose. Cephalically oriented lower lateral cartilages (LLC) are associated with a broad boxy nasal tip. Reorienting cephalically positioned LLC with lateral crural strut grafts is a technique used to correct the nasal tip. An open approach surgical technique is described to evaluate the true orientation of the LLC and correct the boxy nasal tip. Five cases are shown with pre- and post-op pictures. The identical surgical technique is used in all cases with a variation in grafts necessary to create the desired esthetic result. All 5 described cases are on female patients. In all cases, reorientation of the lateral crura with lateral crural strut grafts were performed. In all, 4 of the 5 cases required a columellar strut graft, 3 cases required a shield graft to increase nasal tip projection and control the columellar-lobular angle, and 2 cases required spreader grafts for internal nasal valve support. All 5 cases required a variation of inter and intra-domal suture techniques to refine the nasal tip. A boxy nasal tip with supra-tip fullness is commonly associated with cephalically oriented LLC. Changing the orientation of the LLC to a more favorable angle and using lateral crural strut grafts can be used to not only correct the nasal tip deformity, but also facilitate projecting/de-projecting the nose, changing the rotation of the tip, and also supporting the external nasal valve. Reorienting cephalically oriented LLC is a versatile approach to reshaping the nasal tip. It is a technically demanding maneuver that when executed, allows complete control of the nasal tip complex. We have used this approach in many cases involving a boxy nasal tip with long ptotic tips and poorly supported external valves.

A Modified Technique in Rhinoplasty: A Septal Extension Graft Complex Using Septal Cartilage, Ethmoid Bone, and Auricular Cartilage.

Due to the small and weak septal cartilage of Asians, it is a challenge to obtain ideal tip projection and nose lengthening in this population by performing septal extension grafts with only septal cartilage. The aim of this study was to introduce a septal extension graft complex incorporating nasal septal cartilage, the perpendicular plate of the ethmoid bone, and bilateral auricular cartilage, and to examine its effectiveness in terms of morphological and mechanical support. Septal cartilage was harvested under an endoscope according to standard techniques. Two pieces of the perpendicular plate of the ethmoid bone, placed on either side of the "L" strut, served as 2 spreader grafts. A double layer of auricular cartilage was fixed as columellar strut grafts. Three-dimensional facial scanning was used to examine the change of 3 parameters. Nasal tip resistance was evaluated by a digital Newton meter. In total, 25 patients were followed up postoperatively for a mean of 25.9 months. The analysis showed significant differences in both contour parameters and nasal resistance: nasal length (mean [standard deviation], 41.4 [4.0] vs 46.2 [3.4] mm, P < 0.05) and nasal tip projection (21.3 [3.2] vs 24.4 [2.7] mm, P < 0.05) appeared to increase postoperatively, whereas nasolabial angle (117.6° [5.9°] vs 109.5° [5.3°], P < 0.05) showed a significant decrease after surgery. The resistance of the nasal tip also increased significantly (P < 0.05) at displacements of 1, 2, and 3 mm. All patients were satisfied with the aesthetic results, and no serious complications occurred. This kind of modified septal extension graft technique can effectively adjust nasal morphology for short-nose East Asians.

COMPARISON BETWEEN COLUMELLAR STRUT AND TONGUE-IN-GROOVE TECHNIQUE, AS TO THE ROTATION AND PROJECTION EFFECTS OF THE NASAL TIP: A RETROSPECTIVE STUDY

Rhinoplasty is one of the most challenging facial plastic surgeries. Some authors claim that this surgery should include stabilization of the base of the nose by means of some technique — for example, grafts (columellar strut, septal extensor) or sutures (tongue-in-groove). To try to elucidate which technique is ideal, this study evaluated the effects on nasal tip rotation and projection, comparing columellar strut to the tongue-in-roove technique. A retrospective study was conducted, which consisted of a preoperative and postoperative photographic analysis of patients who underwent rhinoplasty, in 2017 and 2018, at the Instituto Paranaense de Otorrinolaringologia (Curitiba/PR, Brazil) The Rhinobase® program was used to obtain measurements. After data analysis, it was observed no statistically significant difference between the groups, which was also observed by some authors who carried out similar studies in other countries. It can be concluded that both strut and tongue-in-groove are similar techniques for maintaining nasal tip projection and rotation in the postoperative period of rhinoplasty

Columellar strut grafts versus septal extension grafts during rhinoplasty for airway function, patient satisfaction and tip support

Different techniques exist to provide tip support in rhinoplasty. There is little evidence to provide a consensus on the most effective choice.Evaluating columellar strut graft (CSG) and septal extension grafts (SEG) for their influence on airway function, patient satisfaction and tip support.A retrospective cohort study was undertaken on 165 adult patients who underwent open rhinoplasty with either a CSG or SEG, from February 2012 to August 2019 in a single tertiary facial-plastic practice in Sydney, Australia. Operations were for both cosmetic and functional indications, and both primary and revision cases were assessed. Airway testing and patient-reported outcomes (PROMs) were performed preoperatively and at least 6 months following the procedure. Photographic tip analysis was taken from approximately 4 and 12-month postoperative photographs.Nasal peak inspiratory flow (NPIF) and total nasal airway resistance (NAR) were the primary airway functional outcomes. The primary PROMs analysed were a visual analogue scale (VAS) for nasal obstruction and 13-point Likert scale for global cosmesis, the Nose Outcome Symptom Evaluation (NOSE), and the nasal obstruction score. Tip support was determined by the nasolabial angle (NLA) and Simon's ratio as assessed by Rhinobase developed by Apaydin et al. on lateral Frankfort plane photographs. Data normalised as an improvement over preoperative baseline, accounting for individual variability.A total of 165 patients was assessed (35.2 ± 12.9 yrs, 72% female), 100 (61%) of which received SEG. There were similar nasal airway assessments between CSG and SEG groups, with ΔNPIF (20.0 ± 42.1 L/min v 19.9 ± 44.9 L/min, p = 0.983) and Δ "obstructed" NAR (-1.13 ± 1.90 v -1.02 ± 4.33 Pa/cm3/s, p = 0.849). Amongst PROMs, a greater cosmetic outcome was seen in the SEG group (7.20 ± 2.97 v 5.69 ± 3.45, p < 0.01) with all other assessments similar between CSG and SEG techniques. Photographic analysis of tip projection showed reduced NLA distortion in the SEG.While greater patient-perceived cosmesis was seen in patients with a SEG, there were similar airflow and patient-reported nasal function between groups. Photographic analysis of tip projection showed SEG patients additionally benefited from less NLA distortion and greater tip maintenance.

The Comparison of the Long-Term Efficiency of Short Columellar Strut Graft and Suture Techniques on Maintaining Nasal Tip Projection and Nasolabial Angle Following Primary Open Rhinoplasty

The Comparison of the Long-Term Efficiency of Short Columellar Strut Graft and Suture Techniques on Maintaining Nasal Tip Projection and Nasolabial Angle Following Primary Open Rhinoplasty

Correction of Severe Secondary Cleft Lip Nasal Deformity.

The lower lateral cartilages (LLCs) are key elements for alar and tip support. Repositioning of both LLCs is an effective procedure for correcting a laterally spreading dome of LLCs and drooping nasal tip in cleft lip nasal deformity (CLND). The alar contour graft has become an essential component of rhinoplasty for correcting the concave or collapsed and retracted alar. Herein, onlay cartilage graft was combined with nasal tip plasty to correct hypoplastic cleft lateral crus or alar rim retraction, and with columella strut to obtain better aesthetic outcomes in patients with severe CLND. Seven patients with severe secondary unilateral CLND, including hypoplastic cleft lateral crus or alar rim retraction, underwent rhinoplasty from October 2013 to April 2020. Both LLCs were isolated and repositioned approximated medially using tip suture technique combined with columella strut. A septal cartilage onlay graft was applied on the hypoplastic cleft lateral crus. Cartilage graft on the nasal tip was performed to further project and enhance the nasal tip. Photogrammetric evaluation of the operated patients and statistical analysis of the obtained data were performed. The average age at operation was 23.5 (range: 17-36) years. The follow-up period was 6-36 (mean, 14.3) months. All patients were enrolled by photogrammetric evaluation. Height of the medial nostril and short axis of the nostril on the cleft side were increased with a statistical significance of P < 0.05, indicating that depressed ala on the cleft side, which is a feature of CLND, was corrected similar to that of the noncleft side. The alar contour cartilage graft, as an effective adjunctive technique, improves the alar margin, prevents the alar rim from collapsing, and provides supports to the cleft-side alar rim. It can be a prophylactic measure to prevent postoperative retraction in patients with weakened LLCs. Lower lateral cartilage repositioning, columellar strut, and nasal tip plasty are useful for correcting severe secondary unilateral CLND.

Are Grafts Effective in Increasing Nasal Tip Projection? Comparing Columellar Strut versus Septal Extension Grafts

Are Grafts Effective in Increasing Nasal Tip Projection? Comparing Columellar Strut versus Septal Extension Grafts

Correction of a Secondary Bilateral Cleft Lip Nasal Deformity in Adults Using Repositioning of Both Lower Lateral Cartilages and Nasal Tip Plasty Through an Open Bilateral Reverse-U Incision.

Correcting a secondary bilateral cleft lip nasal deformity is very complex with many challenges due to its complexity. This study presents the surgical results after correcting a secondary bilateral cleft lip nasal deformity using isolation and repositioning of the lower lateral cartilages, the columellar strut, and an onlay graft on the nasal tip. Eighteen patients who had bilateral cleft lip nasal deformities and who had surgery performed between September 2013 and December 2019 were included in this study. The age of the patients ranged between 19 and 52 years. Open rhinoplasty with bilateral reverse-U incision was performed. The lower lateral cartilages were isolated and repositioned. Nasal tip support is provided using a columellar strut with a septal cartilage or Medpor strut. In the vertical component of the nasal tip, a conchal cartilage graft was used. The mean follow-up period was 2 years (ranging from 1 to 6 years). Fourteen of the 18 patients underwent photogrammetric evaluation. After surgery, the projection of the nasal tip and angle increased, but nasal bridge length decreased. The columella-labial angle significantly increased by 10.1% after surgery which was statistically significant (P < 0.05). The angle between the nostril axes significantly decreased by 46.2% postoperatively and also reached statistical significance (P < 0.05), indicating that the displaced alar base and lower nostril sill improved and the major axis of the nostril changed more vertically oblique. All patients were pleased with their surgical results. The proposed technique was highly effective in correcting secondary bilateral cleft lip nasal deformities in adults.

Efficacy of Polylactic-Co-Glycolic Acid Plate as a Graft Material in Septorhinoplasty

Background and Objectives Polylactic-co-glycolic acid (PLGA) plate has been recognized for its biocompatibility and biomechanical properties and used widely in various clinical fields. The aim of this study was to evaluate the usefulness and reliability of PLGA plate as a graft material in septorhinoplasty.Subjects and Method Medical records were retrospectively analyzed for patients who underwent septorhinoplasty including extracorporeal septoplasty from January 2017 to June 2020. We evaluated demographics, diagnosis, operation techniques, and complications of PLGA plate as a graft material used in these patients.Results A total of 33 patients were enrolled in this study. Twenty-eight were male and 5 were female. The median age was 32 years old. The follow-up period after surgery was 6-32 months, and the mean follow-up period was 18.03 months. The PLGA plate was used in unilateral spreader graft (n=17), bilateral spreader graft (n=10), batten graft (n=3), strengthening of septal extension graft (n=2) and columellar strut graft (n=3), and fixing L-strut during extracorporeal septoplasty (n=12). During the follow-up period, no patient experienced extrusion or exposure of the grafts. Mild complications, such as redness of the columella skin, granulation in the marginal incision site, and pain on the nasal dorsum were observed in three patients; these complications were temporary and patients improved with conservative treatments.Conclusion The PLGA plate may be a useful graft material in correcting deviated nose especially when the harvested septal cartilage is insufficient and if used carefully in limited locations such as L-strut and columella.

Nasal Reconstruction of a Frontonasal Dysplasia via Septal L-Strut Reconstruction Using Costal Cartilage.

Frontonasal dysplasia (FND) is a rare congenital condition. Its major features include hypertelorism, a large and bifid nasal tip, and a broad nasal root. We present our technique of septal L-strut reconstruction using costal cartilage. Retrospective review from June 2008 and August 2017. Under general anesthesia, 6 patients with FND underwent septal reconstruction using costal cartilage via open rhinoplasty. We reconstructed the nasal and septal cartilaginous framework by placing columellar struts and cantilever-type grafts. The patients ranged in age from 6 to 13 years old. All were female. The follow-up period ranged from 8 months to 2 years; we encountered no postoperative complications (infection, nasal obstruction, or recurrence). All patients were satisfied with their nasal appearance. Although the results were not entirely satisfactory from an esthetic point of view, we found that FND can be treated via septal reconstruction with costal cartilage and that the clinical outcomes are reliable and satisfactory. Our approach is a useful option for FND patients.

A Novel Approach to Provide Long-Term Tip Projection and Rotation Stability: Lateral Columellar Strut Graft.

One of the methods applied to ensure the long-term continuity of the desired result in rhinoplasty is to detect it by placing columellar strut between the medial crus. Columellar strut helps to increase tip support and projection. However, the placement of the strut between the medial crus can disrupt the divergence angle and prevent the tip rotation to be at the desired level due to the interaction of the septum with the caudal. in this study, the data obtained by fixing the columellar strut to the lateral faces of the medial crus are shared. in 51 primary rhinoplasty patients who underwent open rhinoplasty, the medial crus was dissected and released. The distance between the footplates and the new domes was measured and the length of the columellar struts was determined. Grafts obtained from cartilage septum were shaped. After symmetry was achieved between the medial crus, the prepared grafts were fixed to the lateral face of the medial crus. Preoperative and postoperative 12th month images were transferred to computer- aided program and nasolabial angles were measured. The obtained data were transferred to SPSS 22.0 (IBM Corp., Armonk, New York, USA) program and statistical comparisons were made. Fifty one patients were included in the study. Thirty eight of the patients were female and 13 were male. The mean age of the patients included in the study was 29.2 years. The mean preoperative nasolabial angle was 90.2 degrees postoperatively, and the average nasolabial angle was 104.2 degrees at 6 months. A statistically significant difference was found between preoperative and postoperative measurements (P < 0.05). Lateral columellar strut is an effective and reliable and novel method for increasing the stability of medial crus, maintaining tip support in postoperative period and increasing tip rotation.

Assessment of Columellar Widening with Columellar Strut Placement

Objective: The columellar strut is a frequently used technique to provide nasal tip support and projection that is commonly thought to increase columellar width. However, systematic review of the effect has not been reported in the literature. We report a quantitative evaluation of the effect of columellar strut placement on columellar width. Methods: A retrospective cohort study of changes in columellar width in base view photographs for patients who underwent primary rhinoplasty with columellar strut placement (n = 35) and the closely related septal extension graft (n = 9) and tongue-in-groove (n = 5) procedures at Mount Sinai Hospital between 2010 and 2017. The ratio of the columellar width to the intercanthal distance was used to standardize the results among patients. Comparisons were made at follow-up periods of &lt;1 week, 2 to 4 weeks, 1 to 3 months, 3 to 6 months, 6 to 12 months, and &gt;1 year of follow-up. Results: Forty-nine patients (41% female; average age of 43 ± 15 years) were reviewed. The columellar width showed a statistically significant increase for all follow-up date ranges with the exception of 1 week and 3 to 6 months post-operatively. At &gt;1 year of post-operative follow-up, the mean increase in columellar width was 8.6% (95% CI, 2.6%-14.5%, P = .0098). No statistically significant differences were noted between open versus closed procedure for all followup visits after the 1 week followup, and no significant difference if a septocolumellar stitch was placed. Conclusions: A columellar strut was demonstrated to lead to an increase in columellar width. Though the effect was modest at a 8.6% increase, this is a potential cosmetic consideration for the surgeon employing its use to provide nasal tip support and projection.

Bilateral Tip Add-On Grafts: Concept, Applications and Complications in East Asian Rhinoplasty.

A solid tip support plays the fundamental role in augmentation rhinoplasty for East Asians. However, the soft tissue envelope is sometimes limited; the bilateral alae and mucosae cannot be transposed to consolidate the full course of the strut. A graft thatserves for the ultimate purpose of elongating the valid length of the strutis therefore necessary. Forty-one female patients, ranging in age from 19 to 35 years (average 26.5 years), received augmentation rhinoplasty surgery that was supplemented by the applications of the bilateral accessory add-on tip grafts. The tip projection was established by columellar strut or septal extension grafts. These crescent-shaped grafts acted like a bridge between the alae and the strut, which aim to provide supplementary volume and surface area to help reduce tension and further define the width and shape of the nasal tip. Patients' own evaluations on the overall improvements of the nose rendered high satisfaction rate. During the follow-up, six cases presented deviated columella and asymmetrical nostrils; three cases had deformed dorsal profile due to graft warping or resorption at 12 to 18-month period postoperatively, and were corrected during revision surgeries. No other major complications were encountered. These accessory tip add-on grafts are intrinsically applicable for East Asians rhinoplasty surgeries. Instead of being utilized as a routine graft for normal circumstances, this pair of accessory tips is an expedient measure to solve a difficult situation. This graft will be particularly necessary in managing a severely short nose with interior soft tissue insufficiency. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Columellar Strut in Correcting the Recurrent Vestibular Stenosis.

Management of vestibular stenosis is always a challenge in rhinology, especially for patients with complete vestibular stenosis. Tip plasty (with columella strut) can be supplemented to the primary surgery, can ensure good functional and cosmetic outcomes in patients with complete vestibular stenosis.

Tip Droop Prevention in Rhinoplasty: Dynamic Effect of Strut Graft on Smiling versus Depressor Muscle Release.

Background:Aesthetic rhinoplasty is one of the most challenging procedures performed by aesthetic surgeons. Tip droop, especially on smiling, may not be noted by the surgeon postoperatively but can be concerning to patients. Our aim was to determine if the division of the depressor septi nasi or its combination with a columellar strut graft during rhinoplasty produce a measurable reduction in nasal tip droop on smiling.Methods:A retrospective casenote and photograph review was conducted on patients who had undergone aesthetic endonasal rhinoplasty, performed by a single surgeon between 2015 and 2019. In total, 29 patients had release of the depressor septi nasi muscle, whilst 11 had release of the muscle along with a strut graft. Lateral smiling photographs were taken postoperatively. Tip droop was measured as a variation of the nasolabial angle from rest to smiling using the Frankfurt line.Results:Photographs were taken at a mean of 14 months postoperatively. In the group who had muscle release only, a mean increase in nasolabial angle of 3.66 degrees was seen when smiling when compared with rest. In the group who had muscle release combined with strut graft, a mean increase of 2.27 degrees was seen. When using a columellar strut along with muscle release, tip droop on smiling was reduced.Conclusions:This study demonstrates that columellar strut grafting in combination with muscle release can alleviate drooping of the tip better than muscle division alone after rhinoplasty. The columellar strut graft provides tip stability and can therefore be used to enhance dynamic outcomes after rhinoplasty.

The Nasal Tip Rotation After Primary Rhinoplasty Using Columellar Strut Graft.

Objective: In this study, we aimed to investigate the degree of nasal tip rotation three months after rhinoplasty using columellar strut graft.Methods: Using photographs of 25 patients who underwent rhinoplasty, we prospectively analyzed nasal tip rotation before, during, and after three months of the surgery. Columellar strut graft was used for all patients for tip support. Standardized left profile images were taken. For evaluation of tip rotation, the nasolabial angle was measured. The results were statistically compared, and a p value less than 0.05 was considered statistically significant.Results: The mean preoperative nasolabial angle (NLA) for the entire group was 91.44°, and the directly postoperative angle measured 108.84°. The mean of postoperative nasolabial angles measured at three-month follow-up was 97.2°. The preoperative, directly postoperative, and three-month postoperative nasolabial angles were all recorded.Conclusion: Considering the results of this study, a postoperative nasolabial angle is increased compared to preoperative angle. However, an occasional dropping of the angle might be seen in following months, which can be linked to several factors.

Rhinoplasty in the Older Adult.

Rhinoplasty in older adults requires unique consideration of the aging nose. The purpose of this study was to systematically review the literature pertaining to rhinoplasty in the aging population, review the senior author's experience, and describe techniques aimed at addressing age-related features. It was hypothesized that consistent age-related nasal dysmorphology is described in the literature and standard rhinoplasty techniques may effectively address these changes. Furthermore, it was hypothesized that rhinoplasty is more commonly performed for posttraumatic and functional indications than for aesthetic reasons. A literature review including publications describing rhinoplasty in patients over 55 years old was conducted. Additionally, a retrospective review of the senior author's cases was performed. Pre- and postoperative photographs were used to compare anthropometric changes. Demographic factors, surgical indications, and operative details were collected. Nine articles met the study criteria. Manifestations of the aging nose included soft tissue atrophy, bony fragility and resorption, tip ptosis, internal and external valve collapse, and worsening dorsal hump. Twenty-seven patients were included in this institutional review. Primary indication for rhinoplasty was posttraumatic deformity in 17 (63%) patients and nasal obstructive symptoms in 10 (37%) patients. Tip refinement and ptosis were addressed through tip grafts (70%), columellar struts (26%), and caudal septal extension grafts (67%). Nasal obstruction was relieved through septoplasty (96%), turbinate ablation (85%), and spreader grafts (70%). This study presents a systematic review of rhinoplasty in the older adult as well as a retrospective review of the senior author's patients. Unique considerations specific to this population should be integrated into treatment planning.

Application of septal extension graft with autogenous septal cartilage and auricular cartilage in rhinoplasty

Objective: To explore the feasibility of reconstruction of nasal tip with septal cartilage and auricular cartilage. Methods: From September 2018 to October 2019, 17 patients (two males and fifteen females) with low noses underwent rhinoplasty under general anesthesia. The age of the patients ranged from 19 to 39, with an average of 27 years old. Among them, all the 17 cases were primary rhinoplasty. During the operation, autologous nasal septum cartilage was used as septal extension graft to extend the caudal septum, and the auricular cartilage was used to enhance the stability of the strut and to elevate the tip for adjusting the shape of nose by making into spreader graft, columellar strut graft, derotation graft and onlay graft. The nasal dorsum was filled with polytetrafluoroethylene. Digital scanning technology was used to evaluate the nasal structure before and after operation. SPSS 22 software was used to analyze the data with paired t-test. Results: The follow-up was from 6 to 12 months, with an avaerge of 7.6 months. Seventeen patients were satisfied with postoperative nasal morphology and height. There was no infection, prosthesis displacement, skin flap necrosis, no auricle deformation and other complications. Statistical software SPSS 22 performed paired t-test on the preoperative and postoperative data obtained by digital technology: postoperative nasal length and nasal tip protrusion increased compared with that before surgery, and it was statistically significant(length:(3.60±0.77)mm, tip protrusion:(3.61±0.64)mm, t value was -19.203 and -23.132 respectively, both P<0.001). The nasolabial Angle was smaller than that before surgery, and the data were statistically significant(3.40°±2.11°,t=6.635, P<0.001). Conclusion: The nasal tip and nasal septum extension complex constructed by autogenous nasal septal cartilage combined with auricular cartilage can increase the length of nasal tip, increase the height of nasal tip and reduce the angle of nasolabial angle.

A Novel Modification of Tongue in Groove Technique (Auto-Septal Projection Graft) in Rhinoplasty.

Derotation of the nasal tip with narrow nasolabial angle is a common nasal deformity that leads to a long nose appearance, named drooping nose. In these patients, there are various techniques described to fix droopy tip and to achieve a desirable nasal tip rotation such as caudal septal extension graft, extended columellar strut graft, tongue in groove, columellar strut graft, and tip rotation sutures. This study aimed to evaluate changes in nasal tip support after modified tongue-in-groove technique (auto-septal projection graft). Forty-two patients who underwent a primary open approach septorhinoplasty using the modified tongue-in-groove technique between June 2017 and March 2019 were retrospectively analyzed. Postoperative and preoperative photographs were analyzed, and nasolabial angle and the nasal tip projection ratio were recorded and compared before and average of 17.3 months after the surgery. Forty-two patients (33 female and 9 male) were included the study. The mean nasolabial angle was 85.7° preoperatively and 99.3° postoperatively. The nasal tip projection ratio was 0.60 preoperatively and 0.64 postoperatively. Both the tip rotation and the tip projection increased significantly after the modified tongue in groove (p<0.05). It seems that modified tongue-in-groove method (auto-septal projection graft) is an effective technique in maintaining tip projection and rotation in rhinoplasty and safe method to correct droopy nasal tip in selected cases. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .