Tongue-in-Groove Setback of the Medial Crura to Control Nasal Tip Deprojection in Open Rhinoplasty

Overview

A tip that projects too far forward is a common complaint in Caucasian and Mediterranean rhinoplasty patients. Correcting it usually means shortening the paired cartilage struts that hold the tip forward. The authors describe a stepwise method combining that shortening with tongue-in-groove fixation, and report both photographic measurements and patient ratings.

Sections of note

• Retrospective review of 22 consecutive patients operated by one surgeon between 2009 and 2011.
• All had open deprojection rhinoplasty using tongue-in-groove plus either footplate resection or medial crural overlay.
• Patient body image relating to the nose improved from 15.14 to 6.55 (p less than 0.01).
• Mean appearance visual analogue score improved from 3.32 to 7.91 (p less than 0.01).
• Projection change was measured on standardised photographs using a modified Goode method.
• Substantial deprojection occurred in 19 patients (86.4 percent), mean ratio 0.06, range 0.02 to 0.16. One patient gained projection by 0.03 and two were unchanged.

What it means for a patient

• The technique reliably brought an over-projected tip back in most of this small group, and patients rated their noses far better afterwards.
• Three of 22 patients did not get the intended reduction, so the result is not guaranteed.
• All operations were by a single surgeon with no comparison technique, which limits how far the numbers generalise.
• The abstract gives no follow-up duration, so how long the corrected projection holds is not stated.

Why this paper matters

Tip projection is one of the hardest dimensions of the nose to control predictably, and surgeons differ on which manoeuvre to use. This paper pairs an algorithm with measured outcomes rather than description alone. What remains open is long-term stability and how the method compares with other deprojection techniques.

Terms

• Nasal tip projection: how far the tip of the nose stands out from the face.
• Deprojection: surgically reducing that forward projection.
• Medial crura: the paired lower cartilage strips inside the columella that support the tip.
• Tongue-in-groove: fixing those cartilages onto the lower edge of the septum to set tip position.
• Footplate resection: removing the flared lower ends of the medial crura.
• Goode method: a photographic ratio used to measure tip projection.