Published September 15, 2022
Preserving Nasal Tip Rotation and Projection in Open Septorhinoplasty
Open septorhinoplasty is a common facial plastic surgery procedure used to repair severe septal deviations, caudal deformities, and significantly crooked noses. The surgery involves dividing the interdomal ligament to expose the septum.
A key step in the procedure is restoring nasal tip rotation and projection, and to understand the long-term effects that occur with healing. The tongue-in-groove, caudal septal extension graft, and caudal septal replacement graft are three techniques used to reconstruct the nasal tip.
Jason D. Pou, MD, Ochsner Department of Otolaryngology, Head and Neck Surgery, collaborated with colleagues in South Carolina and Virginia to assess the 1-year changes in nasal tip rotation and projection in patients who underwent these three procedures. Fifty-seven patients were included in the analysis.
In their comparison of pre- and postoperative photographs, the researchers determined that all three techniques are reliable methods for maintaining nasal tip projection in open septorhinoplasty.
The authors recommend the tongue-in-groove technique for patients with adequate caudal septal length and height and those who can tolerate a slight increase in rotation. Surgeons typically overcorrect with the tongue-ingroove technique because some loss of nasal tip rotation is expected with time.
They recommend the caudal septal extension graft for increasing nasal tip support in patients with insufficient caudal septal cartilage and/or patients who cannot tolerate an increase in tip rotation. The authors suggest that surgeons should consider slight overcorrection of 2° to 3° with the caudal septal extension graft as it experiences the same gravitational forces as the tongue-in-groove technique.
“In our experience, when attempting to maintain preoperative nasal tip rotation, TIG resulted in a significant increase in tip rotation of 2.31 degrees, while CSEG resulted in a significant decrease of 2.1 degrees at 1-year postoperatively,” Dr. Pou explained.
This work was presented at the Combined Otolaryngology Spring Meetings virtual meeting in April 2021 and at the American Academy of Facial Plastic and Reconstructive Surgery virtual meeting in September 2021.
