Morphometric analysis of nasal tip position when comparing caudal septal extension graft versus columellar strut.
Rajendra Sawh-Martinez, MD, MHS, Kevin Perkins, Sarika Madari, Karl Bruckman, MD, DDS, Derek Steinbacher, MD, DMD.
Yale University, New Haven, CT, USA.
Background: Control and maintenance of nasal tip position is critical in rhinoplasty. Two frequent methods to exert tip control are: columellar strut (CS) and caudal septal extension graft (SEG). However, no quantitative data exists comparing the two methods over time. The purpose of this study was to analyze maintenance of tip projection and rotation following either CS or SEG.Methods: A retrospective cohort study of patients undergoing rhinoplasty was reviewed. Three-dimensional photogrammetric evaluation of patients with either CS or SEG to increase tip projection was performed. Anthropometric points were analyzed in a blinded-fashion. Outcome variables were tip projection, nasal length, Goodes' ratio and tip rotation. Results were stratified based on technique, and compared statistically.Results: One hundred and six patients were included. Overall 66% were female, with an average age of 34.5 years. 42% of cases (n=45) employed the use of a CS, and 57% (n=61) employed a SEG. Analysis showed greater maintenance of tip rotation over time in SEG compared to CS (-1.01% change, p=NS vs -5.08% change, p=0.009). Tip projection, nasal length and the Goode's ratio decreased over time for both groups, but was not statistically different.Conclusion: Nasal tip projection and rotation appear to decrease from the immediate postoperative position. In this study, both SEG and CS exhibit similar changes in tip projection with time; while SEG is better able to preserve tip rotation compared to the CS.
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