Initially introduced by the senior author (B.G.) for lengthening the short nose, bilateral extended spreader grafts (BESG) in the form of the tongue-and-groove (TAG) technique have gained additional indications in current septorhinoplasty practice. The purpose of this study is to discuss the evolution of this versatile technique with a literature review and retrospective review of the senior author\'s experience.
PubMed searches were conducted for \"bilateral extended spreader graft\" and \"tongue-and-groove rhinoplasty\". A retrospective chart review was performed for septorhinoplasty patients at the senior author\'s practice between 2015 and 2020.
BESG have been used to realign the deviated nose and control nasal length. In addition to lengthening the short nose, the BESG technique can augment tip projection and align the caudal nose structures. A total of 397 septorhinoplasty patients were reviewed for this study. There were 258 (65.0%) cases of primary septorhinoplasties. The BESG technique was used in 31 (7.8%) patients for the nose elongation, all of whom underwent an open surgical approach. Bilateral spreader grafts (extended and non-extended) were used in 162 (40.8%) patients; among these patients, 135 (34.0%) had columellar struts placed concomitantly.
In addition to nasal elongation, BESG can increase tip projection and better align the tip with the dorsum. The BESG technique continues to be highly consistent and dependable for correcting difficult nasal deformities.
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Different techniques exist to provide tip support in rhinoplasty. There is little evidence to provide a consensus on the most effective choice.
Evaluating columellar strut graft (CSG) and septal extension grafts (SEG) for their influence on airway function, patient satisfaction and tip support.
A retrospective cohort study was undertaken on 165 adult patients who underwent open rhinoplasty with either a CSG or SEG, from February 2012 to August 2019 in a single tertiary facial-plastic practice in Sydney, Australia. Operations were for both cosmetic and functional indications, and both primary and revision cases were assessed. Airway testing and patient-reported outcomes (PROMs) were performed preoperatively and at least 6 months following the procedure. Photographic tip analysis was taken from approximately 4 and 12-month postoperative photographs.
Nasal peak inspiratory flow (NPIF) and total nasal airway resistance (NAR) were the primary airway functional outcomes. The primary PROMs analysed were a visual analogue scale (VAS) for nasal obstruction and 13-point Likert scale for global cosmesis, the Nose Outcome Symptom Evaluation (NOSE), and the nasal obstruction score. Tip support was determined by the nasolabial angle (NLA) and Simon\'s ratio as assessed by Rhinobase developed by Apaydin et al. on lateral Frankfort plane photographs. Data normalised as an improvement over preoperative baseline, accounting for individual variability.
A total of 165 patients was assessed (35.2 ± 12.9 yrs, 72% female), 100 (61%) of which received SEG. There were similar nasal airway assessments between CSG and SEG groups, with ΔNPIF (20.0 ± 42.1 L/min v 19.9 ± 44.9 L/min, p = 0.983) and Δ \"obstructed\" NAR (-1.13 ± 1.90 v -1.02 ± 4.33 Pa/cm3/s, p = 0.849). Amongst PROMs, a greater cosmetic outcome was seen in the SEG group (7.20 ± 2.97 v 5.69 ± 3.45, p < 0.01) with all other assessments similar between CSG and SEG techniques. Photographic analysis of tip projection showed reduced NLA distortion in the SEG.
While greater patient-perceived cosmesis was seen in patients with a SEG, there were similar airflow and patient-reported nasal function between groups. Photographic analysis of tip projection showed SEG patients additionally benefited from less NLA distortion and greater tip maintenance.