The Slit Septal Extension Graft: A Technical Modification for Midline Fixation in Structured Rhinoplasty

Rodrigues JL, Santos VC, Porpino R, Neves JCM, Viana RWM, Ciancio IH, Caropreso CA.

What this paper says

A six-patient series describing a septal extension graft slotted into a slit in the caudal septum, so it sits on the midline with less bulk, with nasolabial angles stable at one year.

Overview

Septal extension grafts are usually fixed side-to-side against the septum, which adds bulk inside the nose and can push the tip off centre. The Brazilian authors describe a "slit" modification that seats the graft within the caudal septum for central fixation. Six primary rhinoplasty patients treated between July 2017 and May 2022 were reviewed (PROCESS guideline), with nasolabial angles measured on standardised lateral photographs before and at 12 months.

Sections of note

Retrospective case series of 6 patients.
Photographs aligned to the Frankfort horizontal plane; paired t-test used.
Reported result: centralised fixation with "measurable angular control" and stable outcomes at 1 year.
Numeric angle changes are not given in the abstract.
The authors call for larger prospective studies.

What it means for a patient

This is a small technical refinement aimed at avoiding a crooked or bulky tip after a septal extension graft.
Six patients and one year of follow-up is preliminary evidence.
Breathing effects were not assessed.

Why this paper matters

It addresses two known drawbacks of the most widely used tip-support graft. Limits: six patients, retrospective, no comparison, no functional data.

Terms

Septal extension graft (SEG): cartilage attached to the septum to control tip projection and rotation.
Caudal septum: the front edge of the septum.
Nasolabial angle: the angle between upper lip and columella, a measure of tip rotation.
Frankfort horizontal plane: a standard head orientation for facial photographs.
PROCESS guideline: reporting standards for surgical case series.

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

From the abstract

“Septal extension grafts (SEG) are widely used to control nasal tip projection and rotation. However, traditional side-to-side fixation may increase graft bulk within the nasal cavity and carries a risk of deviation. The slit extension graft is a modification designed to centralize fixation within the caudal septum…”

Excerpt; the full abstract is on PubMed.