The Effect of the Membranous Tongue-in-Groove Technique on Projection and Rotation in Patients Undergoing Closed Rhinoplasty

Çelikal Ö, Çiçek MM, Dündar G.

PubMed 40968171 Publisher (DOI)Free full text (PMC)

What this paper says

In 52 women having closed rhinoplasty with a membranous tongue-in-groove, tip rotation rose from 100.6 to 116.2 degrees on the table and settled to 108.5 long-term, while the projection ratio went from 0.61 to 0.77 and settled to 0.64.

Overview

Tongue-in-groove (TIG) fixes the medial crura to the caudal septum to set tip rotation and projection. The membranous variant places the caudal septum into a pocket made between the two layers of the membranous septum. The authors retrospectively reviewed 52 closed-rhinoplasty patients treated January 2021 to February 2024, measuring nasolabial angle and Goode's ratio on photographs before surgery, on the operating table, short-term and long-term.

Sections of note

All 52 patients were women, aged 19-37, median 25.
Nasolabial angle: 100.58 before, 116.19 on the table, 113.73 short-term, 108.49 long-term (p < 0.001).
Goode's ratio: 0.61 before, 0.77 on the table, 0.68 short-term, 0.64 long-term (p < 0.001).
Rotation was lost mainly in the long term; projection was lost mainly in the short term.
Level of Evidence III.

What it means for a patient

The tip position seen at the end of surgery is not the final one: about half the rotation gain and most of the projection gain relaxed over time in this series.
The technique still left the tip higher and more rotated than before surgery.
The authors say additional support may be needed to hold results long term.

Why this paper matters

It quantifies how much tip change is lost after a common suture technique, useful for surgeons planning overcorrection. Limits: retrospective, single centre, all female, follow-up intervals not defined in the abstract.

Terms

Tongue-in-groove (TIG): sliding the medial crura over the caudal septum and suturing them, like a tongue into a groove.
Membranous septum: the soft-tissue part of the septum between the cartilage and the columella.
Medial crura: the inner legs of the tip cartilages, inside the columella.
Goode's ratio: tip projection divided by nasal length.
Nasolabial angle: the angle between lip and columella; higher means more upturned.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

Objective: The rotation and projection of the nasal tip are fundamental factors in determining surgical success. The tongue-in-groove (TIG) technique is performed by securing the medial crura to the septum to control nasal tip rotation and projection. Unlike the traditional TIG technique, the membranous TIG variation involves creating a pocket between the two layers of the membranous septum and placing the caudal septum into this pocket. The aim of this study is to evaluate the long-term effects of the membranous TIG technique on nasal tip rotation and projection in patients undergoing closed rhinoplasty.

Methods: Fifty-two patients who underwent closed rhinoplasty using the membranous tongue-in-groove technique between January 2021 and February 2024 were retrospectively analyzed. Preoperative, postoperative operating table, short-term, and long-term postoperative photographs were evaluated. The nasolabial angle and nasal tip projection ratio were recorded.

Results: All patients included in the study were female. The age range was between 19 and 37 years, with a median age of 25. The mean preoperative, postoperative operating table, short-term, and long-term rotation values were 100.58±10.64, 116.19±7.67, 113.73±7.50, and 108.49±8.41, respectively (p<0.001). The mean preoperative, postoperative operating table, short-term, and long-term goode ratios were 0.61±0.05, 0.77±0.05, 0.68±0.05, and 0.64±0.05, respectively (p<0.001). Rotation loss was more pronounced in the long term, whereas projection loss more pronounced in the short term.

Conclusion: The membranous TIG technique is an effective method for stabilizing nasal tip rotation and projection. Additional supportive techniques should be explored to maintain long term LEVEL OF EVIDENCE III: 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).