Tip Support in the Cleft Lip Rhinoplasty: A Comparison of Septal Extension Graft and Columellar Strut Graft

Acil MF, Kucukguven A, Calis M, Ozgur FF.

PubMed 37567945 Publisher (DOI)Free full text (PMC)

What this paper says

In 33 cleft patients randomly assigned to two tip support grafts, the septal extension graft held tip projection more reliably over 12 months than the columellar strut, which lost projection progressively.

Overview

Secondary cleft rhinoplasty needs strong tip support because the framework is weak and asymmetric. The authors compared the two standard support grafts head to head. Thirty three patients were randomly divided between a columellar strut and a septal extension graft, with profile photographs measured before surgery, immediately after, and at 1, 6 and 12 months.

Sections of note

Design: randomized comparison, 33 patients in two groups. Level of evidence I as assigned by the journal.
Measures taken from profile photographs: the AT over AN ratio, the NAT angle, the Goode ratio and the columellar-labial angle.
Tip projection by the AT over AN ratio was lower in the strut group and decreased progressively there, whereas in the extension graft group it decreased only until 6 months.
Tip rotation by the NAT angle was higher in the strut group and increased progressively.
The Goode ratio was significantly lower in the strut group and decreased progressively, while in the extension graft group it did not differ between follow up points.
The columellar-labial angle decreased in both groups with no significant difference. Stated conclusion: the septal extension graft gives more reliable long term results here.

What it means for a patient

A cleft nose loses tip projection more readily than an unoperated nose, so graft choice matters more here.
The strut group kept dropping and rotating upward across the whole year, while the extension graft group stabilized after six months.
Limits: 33 patients split between two groups is small, the level I grade sits oddly with a study of that size, and only shape was measured.

Why this paper matters

Cleft rhinoplasty results deteriorate over time more than other rhinoplasty, and support graft choice is one of the few controllable factors. A randomized comparison with serial measurement is uncommon in this field. Longer follow up into adulthood would be needed to confirm the difference holds.

Terms

Septal extension graft: cartilage fixed to the septum that carries the tip in a set position.
Columellar strut: a cartilage post placed between the nostrils to support the tip from below.
Tip projection: how far the tip stands out from the plane of the face.
Goode ratio: a photographic measure of tip projection relative to nasal length.
Columellar-labial angle: the angle between the columella and the upper lip.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Background: We aimed to comparatively analyze nasal projection and rotation changes in patients that underwent secondary cleft rhinoplasty with a columellar strut graft (CSG) or septal extension graft (SEG).

Methods: Thirty-three patients were randomly divided into two groups. Preoperative, intraoperative (immediate postoperative), postoperative 1-, 6- and 12-month profile view pictures were analyzed. The nasion (N), alar base-cheek junction (A), tip defining point (T), columella (C), and lips (L) were marked. The AT/AN ratio, NAT angle, Goode ratio, and columellar-labial angle (CLA) were measured.

Results: Regarding tip projection, the AT/AN ratio was lower in CSG group compared to SEG group postoperatively. In CSG group, there was a significant progressive decrease in the AT/AN ratio, whereas in SEG group, it decreased until postoperative 6 month. Regarding tip rotation, the NAT angle was higher in CSG group postoperatively and increased progressively. In SEG group, the NAT angle was lower intraoperatively compared to the postoperative period, whereas it did not differ significantly in-between follow-ups. The Goode ratio was significantly lower in CSG group compared to SEG group postoperatively. In SEG group, the Goode ratio was significantly higher intraoperatively compared to the postoperative period, but it did not differ significantly in-between follow-ups. In CSG group, the Goode ratio decreased progressively. The CLA decreased in both groups, but there was no statistically significant difference between the groups.

Conclusion: Secondary cleft lip rhinoplasty is a distinct subgroup of rhinoplasty that necessitates stable and strong tip support. SEG provides more reliable and predictable long-term results in secondary cleft lip rhinoplasty than CSG.

Level Of Evidence I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).