The comparison of the surgical tecniqes to improve the nasal tip projection and rotation on open tecniqe septorhinoplasty

OBJECTIVE: In this study, we aimed to detec and compare the efficacy of different surgical techniques (suture and graft) to improve nasal tip projection and rotation in open technique septorhinoplasty. MATERIALS: A total of 89 patients who underwent primary septorhinoplasty surgery with open technique due to the lack of nasal tip projection and rotation were examined, retrospectively. Patients were divided into five groups according to the techniques that were used during surgery. Group 1; included 42 patients used the transdomal suture; Group 2; included 10 patients used the projection control suture; Group 3; included 13 patients used the lateral crural steal suture; Group 4; included 14 patients used onlay tip graft (cap, peck); and Group 5; included 42 patients used the shield graft. Preoperative photographs and postoperative photographs which were taken at 1st, 3rd, 6th, 12th, 36th, 60th months by considering the photo shoot rules by the same surgeon were analyzed in all patient who were included to the study. To evaluate the nasal tip rotation and projection, the right lateral side photographs were used and Nasolabial angle, Nasofrontal angle, Type angle, Nasofacial angle, Byrd-Hober ratio, Simons ratio, Goode rate, Crumley-Lancer rate and Powell-Modified-Bam rate were measured. The measurements were recorded with the help of Imagej programme. RESULTS: Nasofrontal angle measurements did not show statistically significant differences in any of the groups (p>0,05) between preoperative photographs and postoperative photographs that were taken at 1st, 3rd, 6th, 12th, 36th, 60th months. Considering the first postoperative year's photos, statistically significant differences were found in the measurements of tip angle and Nasolabial angle in all groups (p <0.05). Statistically significant differences were found in the measurement of Nasofacial angle and Simons rate in only Groups 1, 2 and 3; of Byrd-Hobar rate in Group 1, 2, 3 and 4; of Goode rate in Group 1 and 2; of Crumley-Lancer rate in only group 2; and Powel-Modified-Baum rate in Group 1, 3 and 4 (p <0.05). The evaluation of photographs at 36th and 60th months, statistically significant differences were found in Nasolabial angle measurements of Groups 1, 2 and 4 at only 36th month measurements, in Tip angle and Byrd-Hobar rate measurements of Group 1 at 36th and 60th months measurements, and of Group 2 and 4 at only 36th month measurements, in Nasofacial angle measurement of Group 4 at only 36th month measurements, in Simons rate measurements of Group 1 at only 36th month measurements, in Goode rate measurements of Group 1 at only 36th and 60th months measurements, in Powel-Modified-Baum rate measurements of Group 1 at only 60th month measurements (p <0.05). In addition to these, there were no statistically significant differences in Crumley-Lancer rate measurements in none of the groups at postoperatively 36th and 60th months (p> 0.05). CONCLUSION: In this study suture techniques and onlay tip graft from graft techniques were found effective techniques to improve the projection and rotation of the nasal tip at postoperative 12th month measurements, statistically. It was observed that, transdomal suture and projection control sutures from suture techniques, and onlay tip graft from graft techniques were effective techniques on the tip projection and rotation, of the nasal tip at the comparison of 36th month measurements and moreover, only transdomal suture from all techniques was found effective on rotation and projection of the nasal tip at the comparison of 60th month measurements. According to these results, to evaluate the techniques that are used to improve nasal tip projection and rotation, it is thought that more studies which consist of larger case series and have more long-term follow-up are required.