Comparative clinical study with a novel technique for stabilization of the nasal tip projection and rotation: fixation of the septum and the strut graft through the septal cartilage autoextension

"The Jigsaw Puzzle Locking Technique" to Augment the Stabilization between the Septal Cartilage and Extension Graft in End-to-End Suture Fixation

INTRODUCTION

Nasal tip stability is crucial for long-lasting results. Usage of the extension graft is one of the most reliable stabilization techniques. With a septum in the midline, the extension graft is fixed end to end. The "jig-saw puzzle technique" reinforces this end-to-end fixation. The specific protrusion on one piece of the puzzle is inserted in a groove on adjacent piece. This settlement provides stabilization between the pieces. Application of this philosophy between the nasal septum and extension graft may provide a long-term fixation.

MATERIAL METHOD

Between April 2022 and March 2024, the "jig-saw puzzle technique" was applied in 26 female patients. Trapezoid-shaped protrusion was created at the septum. Similar indentation was created at the extension grafts. The protrusion is then settled in the indentation. The preop, immediate postoperative and one-year postoperative pictures are compared to assess the rotations and projections with Adobe Photoshop Program.

RESULTS

All 26 patients were females with mean age 27.5 years (20-32). Satisfactory graft stabilization was obtained without loss of projection and rotation in all patients. Statistically significant difference was found between the preoperative, immediate postoperative and postoperative 1-year projection and rotation assessments of the patients (p = 0.001; p < 0.01). The results were evaluated at a 95% confidence interval and significance was evaluated at p < 0.05 level. These statistical analyses verify that both projection and rotation were preserved with jig-saw puzzle technique.

CONCLUSION

The jigsaw puzzle technique may provide suture-independent, long-term end-to-end fixation opportunity of the septal cartilage and the extension graft.

LEVEL OF EVIDENCE IV

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

BACKGROUND

Refinement of the nasal tip plays an important role in rhinoplasty surgery outcomes and may be considered the most technically challenging aspect of the procedure. Numerous techniques have been described for nasal tip augmentation utilizing grafts. The aim of this study was to systematically review the existing literature on nasal tip grafts and appraise it critically.

METHODS

A PubMed search was performed to identify journal articles related to nasal tip grafts from the past decade. A total of 44 studies met inclusion criteria. The Newcastle-Ottawa Quality Assessment Scale and Jadad scale were used to appraise 38 observational studies and six randomized trials, respectively, to determine the quality of the studies.

RESULTS

Critical assessment revealed that the studies were highly variable in focus and encompassed autologous, homologous, and alloplastic grafts. The quality of the data included an average Newcastle-Ottawa Quality Assessment Scale score of 6.5 (out of 9) and Jadad score of 2.5 (out of 5). A majority of studies (86.4%) included objective outcomes using anthropometric measurements and a portion of studies (27.3%) also included patient-reported outcomes.

CONCLUSIONS

The results of this systematic review suggest that more than one type of nasal tip graft may result in satisfactory outcomes. This review provides an expansive collection of studies on nasal tip grafts, which can serve as an invaluable tool for the plastic surgeon engaging in rhinoplasty.

Technical Variations in the Management of the Medial Crural Reduction According to the Settlement of the Angulation Deformities Over Hypertrophic Lower Lateral Cartilages

BACKGROUND

Medial crural (MC) overlay is reliable method used in tip deprojection. Most cases with lower lateral cartilage (LLC) hypertrophy present by variations of MC and dome shapes needing specific technical maneuvers.

METHODS

Thirteen hundred fourteen primary rhinoplasties were performed between 2018 and 2021. Patients with LLC hypertrophy who underwent MC deprojection were analyzed. Three variations in LLC hypertrophy were recognized. In type I, tip-defining points (TDP) were localized at the median plane with no angulation deformities at the LLC, which was managed by horizontal cuts of the lobular segments 4 to 6 mm below the domes. The cut fragments overlapped for 2 to 5 mm. In type II, TDP was lateralized due to widened divergence angles at the columellalobular junctions, which were managed by horizontal cuts over columellalobular junctions. The cut fragments overlapped 4 to 6 mm. In type III, TDP was localized at the median plane, there were dense angulations at the medial genu, which was managed with symmetrical removal of 4 to 5 mm cartilage from lobular segments. The domes were sutured over the medial segments.

RESULTS

Nineteen patients with LLC hypertrophy were included in the study among 314 patients. Twelve patients were female and 7 patients were male. The mean age was 32 years (25-42). Type I, II, and III LLC hypertrophies were detected in 10, 3, and 6 patients, respectively. A harmonious relationship between dorsum and tip and satisfactory tip stability was reached in all patients.

CONCLUSIONS

By classification of variations of MC and domal shapes, LLC hypertrophies may be managed with proper technical maneuvers specific to each type.