The Plug-in Graft, the Essential Supplement for a Stable Cartilaginous Framework in Rhinoplasty

Overview

A stable cartilage framework is the foundation of a successful rhinoplasty, but the curve of the front septal angle usually does not match the added tip graft, leaving a structural gap. That gap can allow the tip to rotate after surgery. The study describes a supplementary graft that fills it, and assessed whether doing so produced a more stable framework and better sustained tip position.

Sections of note

• Retrospective collection of intraoperative measurements and complications, with three dimensional photographic assessment; 31 female patients aged 18 to 41 completed the study.
• Anthropometric points were analysed in a blinded fashion.
• Outcome variables were tip projection, nasal length, Goode's ratio and tip rotation.
• Intraoperative measurements of counterrotating force indicated a stabilizing effect from the graft.
• Postoperative analysis showed maintenance of tip position over time.
• Tip projection and nasolabial angle decreased slightly over time, but the differences were not statistically significant.
• The authors state the graft consolidates the whole cartilage framework in rib based procedures.
• They state it justifies the technical difficulty and longer operating time involved.

What it means for a patient

• The graft addresses a specific mechanical weakness, a gap where the tip graft meets the septum, which lets the tip rotate.
• Tip position held over the follow up period, with only minor unmeasurable changes.
• Thirty one patients from one group with no comparison arm is limited evidence.
• The abstract does not state the length of follow up, and blinded analysis applied to the measurements rather than to the surgery.

Why this paper matters

Loss of tip position after rib based rhinoplasty is a recurring failure, usually attributed to graft warping rather than to a structural gap. This paper identifies a different mechanism and a fix for it. Whether the graft outperforms other stabilizing methods has not been tested.

Terms

• Anterior septal angle: the front upper corner of the septal cartilage.
• Tip graft: cartilage placed at the tip to shape or project it.
• Counterrotation: the tip rotating downward against the intended position.
• Goode's ratio: a photographic measure of tip projection relative to nasal length.
• Stereophotogrammetry: three dimensional measurement built from photographs.
• Nasolabial angle: the angle between the base of the nose and the upper lip.