I often prefer to do a sliding or “jumping” genioplasty to correct this. A jumping or oblique sliding genioplasty can decrease the vertical height and increase the. Osseous genioplasty, the alteration of the chin through skeletal modification, can . the requirement—advancement (sliding/jumping), pushback, sideways—and. Additional degrees of freedom can be obtained by using a jumping genioplasty. • Reduction genioplasty is every bit as difficult as augmentation genioplasty.
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The chin mentum is vital to the human facial morphology genioplastg it contributes to the facial aesthetics and harmony both on frontal and lateral views. Osseous genioplasty, the alteration of the chin through skeletal modification, can lead to significant enhancement of the overall facial profile. A case series was designed to study the long-term results of osseous genioplasty in Indian patients with regard to patient satisfaction, complications, and long-term stability.
All subjects who underwent osseous genioplasty either alone or as a component of orthognathic surgery between January and Decemberwith a minimum follow-up of 2 years, were included.
Dr. Alejandro Nogueira’s Case #IFJA79PQ
The genioplasty was performed using standard protocols of assessment and execution. Post-operative evaluation jumpijg patient satisfaction, complications and radiological evidence of long-term stability. A comprehensive score was formulated for the purpose of the study. Thirty-seven subjects underwent osseous genioplasty with at least 2 years of follow-up in the study period.
This included 17 male and 20 female subjects, with a mean age of Nineteen subjects underwent isolated genioplasty while 18 underwent genioplasty as a part of orthognathic surgery.
Reduction Rhinoplasty | Sliding Genioplasty
The procedures included advancement 22pushback 9side-to-side 4 and vertical reduction 2 genioplasty. Gfnioplasty were no significant complications. The osteotomised segment was well maintained in its new position with good bony union and minimal resorption.
Osseous genioplasty is a safe and effective means of creating a beautiful and balanced facial profile by producing alterations in the chin morphology with minimal complications and excellent and stable long-term results. In addition, it can influence, to a great extent, the apparent length of the face and the nose.
The following is a review of the results of osseous genioplasty performed either in isolation, or as a part of major geniollasty procedure, by a single surgeon, in Indian patients.
From February to Jumpinb39 subjects underwent osseous genioplasty—either alone or as part of a major orthognathic procedure.
Of these, 37 cases had a follow-up of at least 2 years and were included in the study, while the two cases with follow-up of less than 2 years were excluded. The sample included 17 male and 20 female subjects with age at the time of surgery ranging from 15 to 52 years mean age, The follow-up period ranged from 2 years to 4 genoiplasty 11 months with a mean follow-up of 3 years 4 months. Of the 37 subjects, osseous genioplasty alone was performed in 19, while the remaining 18 underwent genioplasty as a part of major orthognathic surgery.
All the patients included in this study presented with complaints of chin deformities retruded or protruding chineither alone or in association with facial dysmorphism and occlusal abnormalities, and genioplasty was planned either as the primary surgical treatment or as a component of orthognathic surgery, respectively. In all cases, an orthopantomogram and lateral cephalogram in addition to 3D reconstructed plain CT scan of face in recent cases since its wide-spread availability along with frontal and profile view photographs of the subject were obtained and evaluated pre-operatively.
This included but was not restricted to studying the relation of standard reference points Pogonion, Glabella, Subnasale on lateral cephalogram and planning the proposed movement on cephalometric tracings.
In cases needing orthognathic procedures, the pre-operative work-up included evaluation of occlusion, construction of dental models, orthodontic manipulation, and model surgery as necessary.
Planning an advancement genioplasty—lateral cephalogram; a pre-operative cephalogram; b post-operative cephalogram; c pre-operative cephalometric tracing confirming retruded pogonion; d post-operative cephalometric tracing showing advanced bone segment restoring a better chin morphology; and e pre-operative planned osteotomy and advancement on tracing.
Planning a pushback genioplasty in conjunction with mandibular set-back in a case of prognathism. In addition to enquiries regarding the exact wishes of the patient vis-a-vis his or her facial appearance, specifically the chin, pre-operative counseling involved explaining the merits and de-merits of the procedure including the possibility of temporary or permanent anaesthesia or paresthesia in the mental nerve distribution.
All procedures were performed under general anaesthesia. Pre-operatively a single dose of antibiotic was administered intravenously which was continued for 3 days in cases of isolated genioplasty, and 5 days in cases with orthognathic procedures. After packing the throat, the lower lip was everted to expose the gingivo-labial sulcus and after infiltration of diluted solution of adrenaline 1 in, an incision was made from one canine to the other, leaving a 0.
Leaving an adequate cuff of muscle toward the tooth roots, sub-periosteal dissection was performed to expose both mental foramina and the lower border of mandible, taking care not to strip the symphysis of all its soft tissue attachments. This soft tissue pedicle[ 7 — 9 ] is vital for long-term viability of the osteotomised segment. The mid-line was marked by drilling a groove with a fissure burr.
A curvi-linear horizontal osteotomy was performed, beginning at the lower border as posteriorly as possible, passing 6 mm below the mental foramen, skirting across the midline below the tooth roots to the lower border on the opposite side. The osteotomy was performed either with a fissure burr or with reciprocating and oscillating saws, ensuring that the cortex on both sides was cut. A pictorial representation of the influence of the direction and orientation of the osteotomy on chin movement is presented in Figure 3.
Influence of the orientation of proposed osteotomy on the vector of movement of chin segment: After confirming rigid fixation, the lower border of the mandible was palpated for any obvious step-deformity which was smoothed with a burr. The gingivo-labial sulcus incision was closed in two layers with absorbable sutures followed by chin strapping as shown [ Figure 4 ] to minimize post-operative swelling. Post-operative chin strapping to reduce edema and aid reattachment of labiomental soft tissues.
Post-operatively patients were advised soft diet, antiseptic gargles, and continued strapping for 5 days following which they could return to their daily routine. The post-operative results of the genioplasty were evaluated with reference to 3 criteria, i. Patients were questioned regarding satisfaction with their post-operative facial appearance specifically with regard to the position, size and projection of the chin and the responses were scored as.
Osseous genioplasty: A case series Deshpande SN, Munoli AV – Indian J Plast Surg
The immediate post-operative and the most recent follow-up lateral cephalograms were compared to determine the presence and magnitude of any movement or resorption of the osteotomised symphyseal segment, which were scored as. A Comprehensive Score was formulated by adding scores from all three categories with the results categorized as: The mean follow-up was 3 years 4 months geniop,asty the shortest and the longest being 2 years and 4 years 11 months, respectively.
However, he did not demand either a reversal or a redo of the procedure. In this case, the patient had been advised and had refused orthognathic bi-maxillary surgery to achieve a better balance between the severely retruded mandible and maxilla and had opted for a genioplasty instead.
Distribution of number of patients undergoing osseous genioplasty in isolation and as a part of orthognathic surgery and those with excellent and good results. Distribution of number of patients according to the type of procedure performed and those with excellent and good results. Bilateral sagittal split osteotomy with asymmetric genioplasty for left mandibular hypoplasia in ggenioplasty year old male subject: Sliding advancement genioplasty for retruded chin in a year-old male subject: Pre-operative a, b and 2 years 2 months post-operative c, d frontal and profile views.
Mandibular setback with genioplasty for prognathism in a year- old female subject: Mandibular setback with osseous genioplasty for laterognathism with Class 3 malocclusion in a uumping male subject: Pre-operative a, b and 2 years 9 months post-operative c, d frontal and worm’s eye views.
Mandibular setback with genioplasty for chin asymmetry in a year-old female subject: Bilateral sagittal split osteotomy for mandibular asymmetry with advancement genioplasty: Note the long screw used for fixation of ramus osteotomy in the region of mandibular molar tooth which was exposed and needed removal.
The comprehensive score suggested that the result of osseous genioplasty was excellent scores 8 and 9 in 35 cases The human chin or mentum has always been a sign of courage and optimism.
Even the artists of yore depicted men of honour—kings and war generals—with prominent chins in their paintings and sculptures. The human chin is subject to numerous morphological variations[ 1011 ] in the sagittal retrogenia or prognathismvertical micro or macrogenia and transverse asymmetry planes. These variations egnioplasty be restricted to the chin or may be a part of a generalized craniofacial disorder, e. Craniofacial microsomia, Treacher-Collins syndrome.
The caveats of facial aesthetics[ 1211 ] describing the ideal position and dimensions of the chin are well known. The chin forms the inferior limit of the visible facial form, and its length contributes greatly to the overall impression of the length of the face,[ 11jumpping ] i.
Also, the chin juming in profile can contribute immensely to the harmony and aesthetics of the face—the role genioplastg a retruded chin in emphasizing genioplasry prominent nasal dorsum is just one example of the same. With the chin occupying a place of such significance in the human facial profile, it comes as a great surprise that it has been often neglected when alterations or improvements in profiles have been demanded by patients.
It was not until the s that surgeons began thinking about altering the contour of the jumpint in order to improve facial features. His procedure, however, was performed on a cadaver through an extra-oral route and the article carried no pictures. Sir Harold Gillies[ 14 ] treated a patient with Treacher-Collins-Franchetti syndrome in with an open-approach genioplasty.
It was in that Obwegeser[ 15 ] published a report describing the procedure of trans-oral osseous genioplasty, thus obviating the need for external scars. Concomitant with the development of osseous genioplasty, the option of onlay genioplasty also became very popular. Historically, various materials have been used to augment the chin, including paraffin, ivory, and methylmethacrylate, to name a few. Genioplaty surgeons initially used autogenous materials including bone grafts iliac crest and costochondral grafts as onlay grafts for augmentation of the mentum.
However, over time, it was observed that most of these grafts underwent resorption since jumpinh were non-vascularised and inserted under gneioplasty tight soft tissue envelope of the labiomental tissues.
This fuelled the race for use of alloplastic materials and over the decades, all kinds and varieties of alloplasts have been used to augment the mentum—silicone, PTFE,[ 16 ] polyamide mesh,[ 17 ] mersilene mesh,[ 18 ] and HDPE. However, alloplasts cannot escape the bane of artificial materials in the human body, i. Specific to genioplasty, alloplastic chin augmentation can only correct mild-to-moderate cases of chin retrusion.
In cases of severe retrognathia, the risk of symphyseal resorption is prohibitively high, while in cases of chin asymmetry, vertical height discrepancy and macrogenia, alloplasts have no role to play.
Osseous genioplasty, on the other hand, is an extremely versatile procedure which can correct the entire range of chin deformities in all three planes[ 24 ]—including sagittal retrogenia, prognathismvertical microgenia, macrogenia and transverse asymmetry.
Adjusting the plane and extent of the mandibular osteotomy,[ 462526 ] along with appropriate addition bone grafting or removal reduction genioplasty of bone permits the surgeon to achieve a wide range of alterations in the symphyseal anatomy in order to get the desired result. In addition to its versatility, osseous genioplasty offers the obvious advantage of using autogenous material; i. Not only is the autogenous bone devoid of the problems of extrusion, but also, since it is vascularised through its muscular attachments on the inferior and lingual aspects, its survival genioplast long-term results are far superior[ 79 ] to jumpingg bone grafts.
With modern systems of osteosynthesis malleable titanium miniplates and screwsretaining the symphyseal segment in its corrected position is extremely easy and quick. Use of electrical drill systems with their ergonomically shaped saws sagittal, reciprocating and oscillating has reduced the time taken for osteotomy tremendously.
As a result, osseous genioplasty today, in experienced hands, takes almost the same time as an alloplastic chin augmentation and can be easily performed as a day-care procedure.
There are several reports[ 27 — 31 ] of the stable and excellent aesthetic results of osseous genioplasty in a variety of settings. Various authors have henioplasty long-term data and found osseous genioplasty to be a safe, simple yet powerful and effective means of altering the chin profile.
In our study, we found that osseous genioplasty is an extremely versatile instrument of change of human chin morphology – it offers the surgeon the ability to mould the native chin into the desired and near ideal form with jumpung ease, irrespective of the pre-operative deformity, with excellent and sustained long-term results. National Center for Biotechnology InformationU. Indian J Plast Surg.
Deshpande and Amarnath V. Author information Copyright and License information Disclaimer. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. Aim and Study Design: Chin deformity, mentoplasty, osseous genioplasty.