Septal Extension Grafts Provide Greater LONG-TERM Stability THAN Columellar Strut Grafts in Primary Rhinoplasty
Structural stability is a key element of consistency in rhinoplasty. Long-term projection and rotation are perhaps the two most important and perceptible attributes of rhinoplasty. Columellar strut grafts and septal extension grafts are commonly used support structures, however their relative effectiveness remains debated. The purpose of this study was to compare the long-term stability of septal extension grafts to columellar strut grafts.
Methods/Technique:
Retrospective review of all primary open rhinoplasties performed by the senior author between 2016 and 2019 was performed. Inclusion criteria included all adult patients undergoing primary open rhinoplasty. Revisionary cases, those utilizing fresh frozen rib graft, and those combined with simultaneous procedures that directly included measurement landmarks (i.e. rhytidectomy) were excluded from study. Patients with less than one-year follow-up were excluded. Data captured included demographic information (age, sex, race) and operative techniques employed (grafts utilized). Standardized professional 2D post-operative imaging was assessed at 2-months (early) and at 12-month (long-term). Digital measurements of projection and rotation were measured on both sides of the face for all photos and averaged. Projection was defined as the distance from the most posterior extent of the ala to the most projecting point of the nasal tip on profile. Rotation was measured as the nasolabial angle. All measurements were normalized using a static landmark across all photos (the tragus-to-cornea distance) to account for minor inter-photo variability in subject distance. Statistical comparisons using the ANOVA test were performed to evaluate changes in projection and rotation over time by graft technique.
Results/Complications:
Chart query yielded 142 patients who met inclusion and exclusion. Of these, 37 patients were treated with a columellar strut and 34 with a septal extension graft. Measured projection loss at one-year was 2.9% for the Columellar Strut group compared to 0.02% for the Septal Extension Graft group (p<0.003). Rotation did not significantly differ between groups.
Conclusion:
Septal extension grafts result in effectively no loss of projection or rotation long-term and allow the surgeon to intra-operatively place the nose exactly where desired. A small degree of projection loss can be expected with the use of columellar strut alone. These long-term graft tendencies should be anticipated and accounted for appropriately during rhinoplasty.