Alar-columellar disharmony using the tongue-in-groove maneuver in primary endonasal rhinoplasty

Overview

When the columella hangs below the nostril rims, too much of it shows from the side. This alar-columellar disharmony is often overlooked in rhinoplasty and can spoil an otherwise good result. The tongue-in-groove maneuver tucks the inner legs of the tip cartilages back onto the septum to lift the columella. The author applies it through the closed approach in first-time rhinoplasty.

Sections of note

• Technique description; no series size, follow-up or outcome data in the abstract.
• Correction of alar-columellar disharmony is described as challenging and often neglected.
• The tongue-in-groove suture had been described in the literature via the open approach.
• The endonasal approach is stated to preserve greater tip support than the external approach.
• Presented as an effective long-term tool for the hanging columella together with other variant anatomy.

What it means for a patient

• A columella that shows too much from the side can be corrected by stitching the tip cartilages onto the septum, and this can be done without an external incision.
• The maneuver also sets tip position and rotation, so it changes more than the columella.
• No results are given in the abstract, so durability and complication rates cannot be judged from it.

Why this paper matters

Alar-columellar relationships are a frequent source of revision complaints, and the tongue-in-groove is one of the few maneuvers that addresses a hanging columella without removing cartilage. This paper extends it to the closed approach. Outcome data remain unreported.

Terms

• Alar-columellar disharmony: an imbalance between the nostril rim and the columella seen from the side, showing too much or too little columella.
• Columella: the strip of skin and cartilage between the nostrils.
• Hanging columella: a columella that sits too low below the nostril rims.
• Tongue-in-groove: setting the medial crura into a pocket on the caudal septum and suturing them there.
• Endonasal approach: rhinoplasty through incisions hidden inside the nostrils.
• Medial crura: the inner legs of the tip cartilages that run down the columella.