Flexible Tongue-in-Groove Technique and Its Effectiveness Compared to Classic Tongue-in-Groove and Columellar Strut Graft Techniques: A Retrospective Analysis of 237 Open Rhinoplasty Cases

Overview

The inner legs of the tip cartilage are almost always supported either by a columellar strut graft or by suturing them to the front edge of the septum, the tongue in groove technique. The authors present a modified version they call flexible tongue in groove and compare all three. Patients operated on between January 2016 and June 2018 were reviewed retrospectively.

Sections of note

• Retrospective analysis of 237 patients; therapeutic level of evidence III.
• Three groups: flexible tongue in groove, 53 patients; classic tongue in groove, 107; columellar strut, 77.
• Standardized side view photographs before surgery and at 1, 6 and 12 months were measured.
• Nasolabial angle measured tip rotation and Goode ratio measured tip projection.
• Both tongue in groove techniques showed a significantly smaller decrease in nasolabial angle from month 1 to month 12 than the strut, P less than 0.05.
• Those differences disappeared when narrower time intervals were compared.
• Both showed significantly higher Goode ratios than the strut at 1, 6 and 12 months.
• No significant difference was found between the flexible and classic variants on any analysis.

What it means for a patient

• Tip position drifts downward after surgery, and the technique used to anchor it affects how much.
• Suturing the tip cartilages to the septum held position better than a free standing cartilage post.
• Measurements came from photographs, and the study was retrospective without randomization.
• Follow up stopped at 12 months, so longer term drift is not captured.

Why this paper matters

Loss of tip rotation and projection over the first year is one of the commonest reasons for revision, and the two anchoring methods compared here are used in most rhinoplasties. This study measures durability across all three at defined intervals. Whether the difference persists past a year is unknown.

Terms

• Tongue in groove: suturing the tip cartilages onto the front edge of the septum to set tip position.
• Columellar strut graft: a free standing cartilage post between the nostrils supporting the tip.
• Medial crura: the paired inner legs of the tip cartilages running down the middle of the nose.
• Nasolabial angle: the angle between the base of the nose and the upper lip, used to measure rotation.
• Goode ratio: a photographic measure of how far the tip projects relative to nasal length.