Alar-columellar and lateral nostril changes following tongue-in-groove rhinoplasty

Overview

Tongue-in-groove fixation attaches the tip cartilages onto the lower edge of the septum, which surgeons describe as improving the relationship between the nostril rim and the columella on side view. That description had not been measured. The authors converted three-dimensional images to scaled profile views and calculated the changes.

Sections of note

• 20 patients, 16 female, median age 31.8. One was a current smoker.
• 94 lateral views analysed at three time points: within 2 weeks, 4 to 10 weeks, and more than 10 weeks after surgery.
• 3D images were converted to 2D and set to scale, then compared with a pairwise t test.
• Measures were exposed lateral nostril area, alar-columellar disproportion, nasolabial angle, nostril height and nostril length.
• Nostril area shown on profile decreased significantly at every postoperative time point, and alar-columellar disproportion was reduced at every time point.
• The nasolabial angle increased significantly at all three time points. Nostril height and length both decreased. Level of evidence 5.

What it means for a patient

• The technique measurably tucks up the nostril show on side view and rotates the tip upward.
• It also shortens the nostril in both directions, which changes the shape of the opening, not just its position.
• Changes were present in the first two weeks and still present past ten weeks, but the longest measurement point is only described as more than 10 weeks.
• Twenty patients at one centre, no comparison group and no satisfaction scores, so this confirms what the operation does geometrically, not whether patients prefer it.

Why this paper matters

Much rhinoplasty teaching rests on descriptions of what a manoeuvre is supposed to do. This study puts numbers behind one such description using 3D imaging. Long-term stability and volumetric analysis are named by the authors as the next questions.

Terms

• Tongue-in-groove: fixing the tip cartilages onto the lower edge of the septum to set tip position and rotation.
• Columella: the strip of skin and cartilage between the two nostrils.
• Ala: the outer wing of the nostril.
• Alar-columellar disproportion: a mismatch on side view between the nostril rim and the columella, seen as too much or too little nostril show.
• Nasolabial angle: the angle between the base of the nose and the upper lip, a measure of tip rotation.