The Tongue-in-Groove Technique in Primary and Revision Rhinoplasty

Overview

Tongue-in-groove is a suture method that slides the paired tip cartilages onto the front edge of the septum and fixes them there, so the tip position is set by the septum rather than by added grafts. This article describes indications and considerations for using it during external primary and revision rhinoplasty. It draws on the authors' clinical experience and the published literature rather than reporting a new patient series.

Sections of note

• The technique is described as conservative but powerful, using sutures rather than added cartilage.
• Stated functions: control tip rotation, control tip projection, set the alar-columellar relationship, straighten a caudal septal deviation, and stabilize the nasal base.
• Described as suitable in primary cases and most revision cases.
• Reported as easily combined with other surgical techniques.
• The authors note the technique has been embedded in rhinoplasty literature and teaching material for 17 years since its popularization.
• Discussion is framed around the external, or open, rhinoplasty approach.
• The abstract states no patient numbers, complication rates, follow-up length, or comparison with alternative tip techniques.

What it means for a patient

• The tip position can be set with stitches to existing structure instead of by inserting a separate strut of cartilage.
• The technique also addresses how the nostril rim sits relative to the columella, which is what makes a nose look hung down or pulled up.
• Because it uses the septum as the anchor, it depends on the septum being straight and strong enough.
• No outcome data is reported here, so this abstract does not show how the technique compares to alternatives.

Why this paper matters

Tip support is the step that most often determines whether a rhinoplasty result holds its shape over years. Tongue-in-groove is one of the two or three dominant ways of achieving it. What the abstract leaves open is how it performs against columellar strut grafts in matched patients over time.

Terms

• Tongue-in-groove: A suture technique fixing the tip cartilages onto the front edge of the septum.
• Tip rotation: How far the tip is turned up or down.
• Tip projection: How far the tip stands out from the face.
• Alar-columellar relationship: How the nostril rim sits relative to the strip between the nostrils.
• Caudal septum: The front lower edge of the septum, just behind the columella.