Evolution of the Septal Extension Graft in Endonasal Rhinoplasty: Long-term Efficacy and Reliability

Overview

The septal extension graft overlaps the caudal septum in the midline to lengthen it and reposition the tip. The Israeli authors describe how their endonasal version has changed since the technique was first described in 2006 and evaluated photographs before and one year after surgery in 60 patients, measuring the nasolabial angle and the Crumley ratio.

Sections of note

• 60 patients, endonasal approach, one-year follow-up.
• Nasolabial angle: 93.75 (SD 9.45) before versus 101.1 (SD 5.3) after.
• The narrower postoperative standard deviation (5.3 versus 9.45) indicates more consistent tip position after surgery.
• Crumley ratio changed from 3.84 to 4.04 (95% CI -0.24 to -0.149; P < 0.001).
• The authors state the technique's adaptations have made it more reliable.

What it means for a patient

• Tip rotation and projection can be raised and made more uniform with this graft through a closed approach.
• Results held at one year; longer follow-up is not reported.
• Average rotation gain was about 7 degrees.

Why this paper matters

It provides measured one-year data for the endonasal septal extension graft. Limits: single group, retrospective, photographs only, no functional outcomes.

Terms

• Septal extension graft (SEG): cartilage fixed to the front of the septum to control tip position.
• Nasolabial angle: the angle between the upper lip and columella; higher means more upturned.
• Crumley ratio: a 3-4-5 triangle method of describing tip projection relative to nasal length.
• Endonasal: through incisions inside the nose.