Y-Columellar Strut Graft: A Method for Reconstructing the Nasal Tip in Primary and Revision Rhinoplasty

Overview

The authors describe a new tip support graft, the Y-columellar strut, carved from ear cartilage in a Y shape with two upper limbs they call wings. It was used to raise tip projection and restore tip contour in both first time and revision surgery. Thirty seven patients with congenital, acquired or iatrogenic tip malformation were treated, using a short wing version or a long wing version.

Sections of note

• Design: case series of 37 patients with congenital, acquired or iatrogenic deformities. Level of evidence therapeutic IV.
• The short wing variant was used to raise tip projection in primary rhinoplasty; the long wing variant corrected earlier surgical damage to the alar cartilages in revision cases.
• Front, oblique and side photographs were reviewed blinded at one year for tip shape and projection.
• All patients showed improved tip position; the graft increased the nasolabial angle, indicating tip rotation, independent of deformity type, p less than 0.00001.
• Short wing and long wing versions did not differ significantly from each other.
• Three patients with congenital tip malformation had mild tip deviation at one year, and one had a mild bridge irregularity unrelated to the graft. No negative outcomes occurred in revision patients.

What it means for a patient

• The graft uses ear cartilage, so the septum and ribs are left alone as donor sites.
• The blinded photograph review at one year is a methodological strength, since the reviewers did not know which technique was used.
• Limits: 37 patients, no comparison group receiving a conventional strut, follow up of one year, and outcomes measured on photographs rather than by patient questionnaires or breathing tests.

Why this paper matters

Tip support determines whether a nose keeps its shape, and surgeons differ over the strut versus septal anchoring. A paired symmetric ear cartilage option matters most in revision cases where septal cartilage is used up. Whether the Y-strut holds projection as well as a septal extension graft is untested here.

Terms

• Columellar strut: a cartilage post placed between the nostrils to support the tip.
• Auricular cartilage: cartilage harvested from the ear.
• Nasolabial angle: the angle between the nose base and upper lip, a measure of tip rotation.
• Alar cartilage: the paired lower cartilages forming the nasal tip and nostrils.
• Iatrogenic: caused by previous medical or surgical treatment.