Tongue-in-Groove Technique for Rhinoplasty: Technical Refinements and Considerations

Overview

Tongue-in-groove fixes the inner arms of the tip cartilages onto the front edge of the septum with stitches, so the septum sets the tip position. The authors use it routinely and this review covers the technical detail and how to avoid its recognized drawbacks, illustrated with patient examples.

Sections of note

• Maintaining or increasing tip support, and addressing tip projection and rotation, is described as a key concept in successful rhinoplasty.
• The technique creates a strong sutured connection between the septum and the medial crura.
• Stated criticisms of the method: it may cause stiffness of the nasal tip and columellar retraction.
• The authors use it routinely during anterior septal reconstructions, a modified extracorporeal septoplasty technique.
• It is also used in primary and revision aesthetic and functional rhinoplasties.
• The review discusses technical aspects and how the pitfalls can be avoided, illustrated by several patient examples.
• No patient numbers, complication rates, outcome measures, or follow-up appear in the abstract.

What it means for a patient

• Tip position is set by stitching to the septum rather than by inserting a separate support graft.
• Two recognized downsides are a tip that feels stiff and a strip between the nostrils pulled up too far.
• The technique depends on the septum being strong and straight enough to act as the anchor.
• This is a review of expert practice with no measured outcomes, so it does not report how often the pitfalls occur.

Why this paper matters

Tongue-in-groove is one of the dominant tip support methods, and its criticisms are widely repeated but rarely addressed in technical detail. This concentrates on avoiding them. No data is offered on the rate of tip stiffness or columellar retraction with the refinements described.

Terms

• Tongue-in-groove: A suture technique fixing the tip cartilages onto the front edge of the septum.
• Medial crura: The inner arms of the tip cartilages, running down into the columella.
• Tip projection: How far the tip stands out from the face.
• Columellar retraction: The strip between the nostrils pulled upward, changing nostril appearance.
• Extracorporeal septoplasty: Removing the septum, reshaping it outside the nose, and replacing it.