Comparative Analysis and Long-Term Results of Various Septal Extension Graft Types

Abstract

Shape, tip projection, and position can be controlled by the use of septal extension grafts (SEG). A retrospective cohort study of patients undergoing primary and secondary rhinoplasty was reviewed. The purpose of this study was to analyze maintenance of nasal length, dorsal length, and nasolabial angle postoperatively comparing different types of SEG using standardized photography and digital measurement. Two-hundred twenty-one patients undergoing rhinoplasty were included. There was a statistically significant change regarding the nasolabial angle during the time of follow-up decreasing from 97.53 to 95.30 degrees. No changes could be found in dorsal and nasal length. There was no significant difference among the techniques used to fixate the SEG. The nasolabial angle appeared to decrease from the position 2 weeks postoperatively without changes in the dorsal and nasal length. This means that the decrease in the nasolabial angle depends on the swelling effect and not on drooping of the tip confirming the reliability of SEG over time.

Bony Cartilaginous Graft in Unilateral Cleft Lip Rhinoplasty

“…Brandstetter et al and Caughlin et al have shown that the long-term result does not depend on the individual technique of graft fixation: the side-to-side fixation, end-to-end fixation with unilateral splinting (perpendicular plate or thinned ethmoid bone), end-to-end fixation with extended spreader grafts, and with polydioxanone absorbable plates. 16,17 The nasolabial angle reduced 2.2 degrees from the position 2 weeks postoperative, 16 attributed to postoperative swelling, without changes in the dorsum and nasal length or tip projection after long-term follow-up. 16,17 For esthetic outcomes of secondary cleft rhinoplasty, the aims are to improve the nasal profile and nasal form on the frontal profile view.…”

“…16,17 The nasolabial angle reduced 2.2 degrees from the position 2 weeks postoperative, 16 attributed to postoperative swelling, without changes in the dorsum and nasal length or tip projection after long-term follow-up. 16,17 For esthetic outcomes of secondary cleft rhinoplasty, the aims are to improve the nasal profile and nasal form on the frontal profile view. 18 Key maneuvers include centralizing the anterocaudal septum; providing structural support and/or spreader graft for nasal airway; chondromucosal advancement of the LLC with interdomal and intercartilaginous sutures, lateral crural strut; and/or alar base repositioning.…”

“…The SEG is not only an effective method for the correction of a short nose,15 but also a very reliable graft for long-term support of the tip position. Brandstetter et al and Caughlin et al have shown that the long-term result does not depend on the individual technique of graft fixation: the side-to-side fixation, end-to-end fixation with unilateral splinting (perpendicular plate or thinned ethmoid bone), end-to-end fixation with extended spreader grafts, and with polydioxanone absorbable plates 16,17. The nasolabial angle reduced 2.2 degrees from the position 2 weeks postoperative,16 attributed to postoperative swelling, without changes in the dorsum and nasal length or tip projection after long-term follow-up 16,17…”

“…23 The thin and flattened PPE grafts in the literature are employed to enhance caudal septum stability. 16,[19][20][21]24 Through these efforts, an optimal nasal tip rotation and projection via the efficient use of minimal septal cartilage was achieved. Our results show the improvement of tip projection as well as tip rotation.…”

“…Ingrowth of tissue within and around the graft can stabilize the nasal tip in its surgical position without collapsing 23. The thin and flattened PPE grafts in the literature are employed to enhance caudal septum stability 16,19–21,24. Through these efforts, an optimal nasal tip rotation and projection via the efficient use of minimal septal cartilage was achieved.…”