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Surgical Pearls
Jan/Feb 2019

Nuances of the Tongue-in-Groove Technique for Controlling Tip Projection and Rotation

Author Affiliations
  • 1Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California
JAMA Facial Plast Surg. 2019;21(1):73-74. doi:10.1001/jamafacial.2018.0948

A central component of successful rhinoplasty surgery is maintaining or increasing tip support, as well as addressing tip projection and rotation. The tongue-in-groove (TIG) technique is a method to achieve this goal and has been most extensively described by Kridel and colleagues in 1999.1 This method uses sutures to create a strong connection between the septum and medial crura to control tip rotation and projection. In our practice, TIG is routinely used during anterior septal reconstruction (a modified extracorporeal septoplasty technique), as well as in primary and revision aesthetic and functional rhinoplasties.2,3 Criticisms of this method include that it may cause stiffness of the nasal tip and columellar retraction. We describe how these obstacles can be overcome, as well as the biomechanics and geometry of the tip/tripod complex in relation to the TIG technique.