• Certain tip-projecting techniques require insertion of grafts and/or implants into the premaxillary region. These grafts may extend anteriorly into the columella or may have to reach all the way to the tip to exert the projecting forces exactly where the surgeon wishes to have them applied. The most direct technique for insertion of these long grafts is one of the columella-splitting maneuvers, but some patients will not accept the external scarline necessitated. An intraoral approach can be used in these patients or in any others in whom the surgeon wishes to have no external scar. It allows good exposure, easy insertion of the grafts and/or implants, and secure closure for stabilization and fixation of the grafts. ( Arch Otolaryngol 1982;108:187-193)
