Tongue-in-Groove Technique

The Problem

• 1.

  Caudal septal deviation

• 2.

  Excess columellar show

• 3.

  Ptotic nasal tip

The Background

The tongue-in-groove (TIG) maneuver is an adaptation of previously described techniques. In 1934, Rethi described elevation of the septal membranes along the septal angle and caudal septum and securing the exposed septum between the medial crura in order to prevent nasal tip ptosis. In 1950, Fred described the “invaginating technique” to maintain tip projection. The caudal septum is exposed through a transfixion incision and placed in a pocket in the middle of the columellar tissue. Joseph originally proposed in 1931 modification of nasal tip projection with advancement and fixation of the medial crura with septocolumellar sutures as was later translated to English in 1987. Since 1950 there was no mention in the literature of such maneuvers until Kridel et al. in 1994 reported on a 10-year experience and described a refined technique and coined the term, “tongue-in-grove.” The TIG maneuver is a fundamental adjunctive technique in rhinoplasty to correct excess columellar show, address caudal septal deviation, or modify nasal tip rotation.