Comparison of the effects of columellar strut and septal extension grafts for tip support in rhinoplasty

Overview

Two grafts are used to support the tip from below: a strut floating between the tip cartilages, and a septal extension graft fixed to the septum. Surgeons debate which holds the tip position better. The authors compared early and long-term measurements of projection and tip angle in patients who had one or the other.

Sections of note

• 36 patients, single surgeon, given either a columellar strut or a septal extension graft.
• Measures: ratio of nasal projection to nasal length, and columella-labial angle, compared between early and long-term follow-up.
• Both grafts increased projection, and the increase was stable over time.
• Some of the early increase in projection was lost over time in both groups.
• Loss was smaller in the septal extension group on clinical and numerical observation, but the between-group difference was not significant.
• Level of evidence IV; the abstract does not state group sizes, follow-up length or the amount of loss.

What it means for a patient

• Either graft can lift the tip and keep it lifted, and a little settling after surgery is expected with both.
• A graft anchored to the septum settled less in this study, but the numbers were too small to prove a difference.
• Single surgeon, small groups and unstated follow-up length; the abstract gives no complication data.

Why this paper matters

The strut versus septal extension debate runs through tip surgery, and this is one of the few direct comparisons. Its result points toward the septal extension graft for stability without proving it. Larger comparative studies remain needed.

Terms

• Columellar strut: a cartilage rod placed between the medial crura to support the tip, not fixed to the septum.
• Septal extension graft: cartilage fixed to the front edge of the septum to set tip position rigidly.
• Tip projection: how far the tip stands out from the face.
• Columella-labial angle: the angle between the columella and the upper lip, a measure of tip rotation.
• Caudal septum: the front lower edge of the septum, just behind the columella.
• Level IV evidence: a case series without randomization.