**7. Basic grafts in tip plasty**

#### **7.1. Collumellar strut**

The columellar strut is a quadrangular piece of cartilage that is inserted and fixed, in a pocket between the two medial crura. The columellar strut is aimed to reinforce tip support; the strut may indirectly have positive effects on tip rotation and increasing tip projection (Figure 9). [16].

#### **7.2. Cap graft**

The cap graft is a small ovoid cartilage that is prepared from septal cartilage, remnants of excised cephalic trimming or choncal cartilage. This graft is placed and fixed over the domes (Figure10). Cap grafts may have several aesthetic results namely:


**3.** Covers the irregularities of the tip cartilages

**Figure 9.** Collumellar strut

**Figure 8.** Interdomal suture

**6.1. Common mistakes**

**7.1. Collumellar strut**

**7.2. Cap graft**

**2.** Shapes the tip

**7. Basic grafts in tip plasty**

**1.** Slightly increases tip projection

definition and is not aesthetically pleasing. [12-15].

756 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2

The interdomal suture should be done in a way that two domes form a 45 degree angle to each other. Careless non-anatomic interdomal suturing will provide a pointed tip that has no

The columellar strut is a quadrangular piece of cartilage that is inserted and fixed, in a pocket between the two medial crura. The columellar strut is aimed to reinforce tip support; the strut may indirectly have positive effects on tip rotation and increasing tip projection (Figure 9). [16].

The cap graft is a small ovoid cartilage that is prepared from septal cartilage, remnants of excised cephalic trimming or choncal cartilage. This graft is placed and fixed over the domes

(Figure10). Cap grafts may have several aesthetic results namely:

**Figure 10.** Cap graft

### **7.3. Shield graft**

Shield graft is a quadrangular piece of a cartilage that is formed and trimmed according to the aesthetic needs of the deformity. A shield graft is generally placed and fixed caudal to the medial crural cartilages (Figure 11).This graft has nearly the same role as a cap graft though its heavier and stronger; there are two specific uses for it:


**Figure 11.** Shield graft

### **8. Crushed cartilage**

A small piece of cartilage is placed in a crusher and with few strokes of a mallet, a smooth soft texture is provided that may be used to cover the irregularities or fill subtle deformities(Figure 12).Tip grafts are best fixed by delicate 6-0 PDS sutures to prevent any future dislodgment or displacement. The skin may be re-draped several times to seek any spicules. Sharp edges or shadows of tip grafts are corrected intra-operatively to avoid later revisions. [22]

**Figure 12.** Crushed cartilage

**7.3. Shield graft**

**1.** To form the bulky tip

**Figure 11.** Shield graft

**8. Crushed cartilage**

**2.** To increase tip projection [17-21]

Shield graft is a quadrangular piece of a cartilage that is formed and trimmed according to the aesthetic needs of the deformity. A shield graft is generally placed and fixed caudal to the medial crural cartilages (Figure 11).This graft has nearly the same role as a cap graft though

A small piece of cartilage is placed in a crusher and with few strokes of a mallet, a smooth soft texture is provided that may be used to cover the irregularities or fill subtle deformities(Figure 12).Tip grafts are best fixed by delicate 6-0 PDS sutures to prevent any future dislodgment or displacement. The skin may be re-draped several times to seek any spicules. Sharp edges or

shadows of tip grafts are corrected intra-operatively to avoid later revisions. [22]

its heavier and stronger; there are two specific uses for it:

758 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2
