title: Comparison of techniques used to support the nasal tip and their long-term effects on tip position.
abstract: OBJECTIVE
  To examine the indications for the use of septal extension grafts, columellar struts, and tongue-and-groove techniques to provide support and set the tip position during rhinoplasty, and to compare the strength of their support and analyze their long-term effects on tip position.
  
  
  METHODS
  The medical records and photographs of patients who underwent external septorhinoplasty during a 2-year period were analyzed. Forty patients had photographs from short-term follow-up (<12 weeks) and were included in the study. The short-term and long-term (>52 weeks) tip positions were compared to determine the maintenance of tip position with each technique. Each stabilization technique was performed on 5 fresh cadavers, and the resistance to displacement of the tip was measured and compared.
  
  
  RESULTS
  Objective measurements in the cadaver analysis show increased resistance to tip displacement with the use of caudal septal extension grafts and tongue-and-groove techniques. There was no difference in the maintenance of tip position between the techniques in analysis of the patients who have undergone rhinoplasty.
  
  
  CONCLUSIONS
  Many factors influence the maintenance of tip position in patients who have undergone rhinoplasty. One should consider using a stabilization technique to help resist displacement of the nasal tip. Clinical and operative findings, as well as secondary effects, are used to help determine which technique should be used.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, Eastern Virginia Medical School, River Pavilion, Ste 1100, 600 Gresham Dr, Norfolk, VA 23507, USA. dobratej@evms.edu
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Dobratz
authors.forename: Vivian
authors.initials: V
authors.lastname: Tran
authors.forename: Peter A
authors.initials: PA
authors.lastname: Hilger
mesh_terms: D000704:Analysis of Variance; D002102:Cadaver; D006801:Humans; D009300:Nasal Septum / Q000637:transplantation; D009666:Nose / Q000033:anatomy & histology / Q000601:surgery; D010781:Photography; D012225:Rhinoplasty / Q000379:methods*; D013536:Suture Techniques; D016896:Treatment Outcome