Caudal extension graft versus columellar strut with plumping graft for acute nasolabial angle correction in rhinoplasty surgery

Abstract

Nasal tip support is an important factor to be considered in rhinoplasty surgery. There are several techniques for improving tip support. Caudal extension graft (CEG) and columellar strut with plumping graft (CSPG) are two methods in rhinoplasty surgery. The final goal of this experimental study is to find the most effective method for tip correction among patients with tip ptosis. In this study, we compare two different methods which are used for the tip correction among patients who suffer from acute nasolabial angle (NLA) and columellar retraction. We performed a randomized clinical trial to compare correction ratio of NLA and columellar show obtained via CEG and CSPG methods. Standardized photographs were taken before the surgery and 12 months after the surgery to compare results between two groups. The mean post-operation NLA was 112.55° in CEG and 104.17° in CSPG (p value < 0.001). Correction ratio of NLA was 22.26° in CEG and 13.77° in CSPG (p value < 0.001). The difference in the mean and the correction ratio of NLA were statistically significant in two groups. The mean post-operation columellar show was 3.75 mm in CEG and 3.44 mm in CSPG (p value < 0.083). The correction ratio of columellar show was 1.76 mm in CEG and 1.20 mm in CSPG (p value < 0.007). The difference in the correction ratio of the two groups was statistically significant. Our study reveals that both techniques properly improve NLA and columellar show, however, CEG is a more stable method in patients with tip ptosis.

The broad base columellar strut for correction of retracted columella and under rotated tip

“…8 Furthermore, the septal extension grafts need a relatively large amount of harvested cartilage which is not always available, also, a part of the harvested cartilage should be spared for other grafts in the majority of cases especially if it was previously used in revision cases. 2 Atighechi et al 9 compared between the use of caudal extension graft and columellar strut with plumping grafts of fragments of cartilage introduced into the columellar base for correction of tip ptosis. They found that both methods were properly correct for the columellar-labial angle and columellar retraction, however, the caudal extension graft showed to be a more stable method in long-term follow-up.…”

Current Surgical Outcomes of Nasal Tip Grafts in Rhinoplasty: A Systematic Review

“…Akkus et al 18 reported that tip position was more stable in cases with SEGs than in those with CSGs. A randomized trial by Atighechi et al 19 concluded that both columellar strut and SEG improve nasolabial angle and columellar show, but SEG is a more stable method in patients with tip ptosis. Bilgili and Çerçi Özkan 20 compared CSG with columellar strut fixated to the septum by a tongue-like extension (septal autoextension).…”

Nasal Reconstruction in Granulomatosis with Polyangiitis: A Two Decade Review

“…The grafts that were more commonly used were cantilever dorsal grafts, 33 L-grafts, 19 tongue-in- groove grafts, 17 , 20 columellar struts, 13 SRG 14 and SEG, 13 , 15 , 34 spreader 35 and extended spreader grafts, 15 batten 26 and lateral crural underlay grafts, 25 plumping grafts, 36 fascia and perichondrium onlay 37 and underlay grafts. The dorsal grafts were fixated in a variety of ways, although some required no fixation due to the size of the dorsal pocket.…”