Single-Step Full-Face Surgical Treatment of the Facial Profile

The present study was performed to describe how much affordable, feasible, and straightforward is the approach the authors called "single-stage full-face surgical profileplasty," tailored to greatly improve the surgery of the facial profiling setting and achieve complete profile correction at the same time. From January 2010 to May 2019, 113 patients (95 females and 18 males; aged 19 - 63 years) were surgically treated for full-face profile amelioration. Profile correction was performed by using a combination of five procedures out of other various previously experienced: forehead fat grafting, rhinoplasty, lip fat grafting, genioplasty, and submental liposuction. All patients were assessed at 1, 3, 6, and 12 months following surgery for assessing the surgical profile treatment (SPT) outcome and any possible side effects of the combined treatment. Facial profile stability at 1 year was taken as the completion point of this treatment. Arnett et al's "Soft Tissue Cephalometric Analysis" (1999) was used to clinically evaluate the soft tissues before and after the SPT. Patients' satisfaction was measured with the Client Satisfaction Questionnaire-8" at 3 and 12 months after surgery. Statistics were used for Arnett et al's evaluation. Almost all the values were consistent and reached the normal ranges indicated by Arnett et al (p < 0.001), confirming that the desired results of the surgical profileplasty have been achieved. Single-stage full-face surgical profile treatment helps in correcting faults of the global facial deformity, in every single treated area, providing an overall improvement in facial aesthetics and harmony. Obtaining the simultaneous correction in the whole face has also the advantage of avoiding multiple surgical procedures, reducing postoperative discomfort, and the overall risks for the patient due to multiple surgical and anesthetic procedures.

Single-Piece Segment Lateralization

Background and Objectives: Correction of lower face asymmetry still remains challenging in maxillofacial surgery. This report describes techniques for the lateral transposition of the symphyseal segment to restore lower face symmetry while maintaining gender-related features in cis- and transgender patients. Materials and Methods: A retrospective review of medical records of 31 patients who attended for esthetic corrective surgery after orthodontic camouflage or orthognathic treatment, or during facial feminization of the lower face between June 2021 and June 2023 was performed. Result: All patients underwent lateralization genioplasty (with or without advancement or setback), either with or without narrowing T-osteotomy supplemented with necessary procedures in order to obtain proper facial balance and desired esthetical effects, such as bichectomy, liposuction, and face and neck lift. The mean asymmetry of the chin was 5.15 mm and was surgically corrected either by single segment lateralization or T-shape narrowing genioplasty depending on the gender and esthetical requirements. No complications were reported. Conclusions: Lateral shift genioplasty serves as a powerful tool in primary and secondary corrective surgery for lower face asymmetry that maintains gender-specific facial features. It may serve either as an additive to orthodontic camouflage or a way to correct previous orthognathic surgery pitfalls. The surgeon performing esthetic genioplasty associated with gender-specific expectations must be trained in facelift and facial liposculpting techniques in order to provide the best results and properly choose the right procedures for the right patients.

Soft-Tissue Response following Genioplasty Combined with Anterior Segmental Osteotomy

BACKGROUND

The authors' main aim was to analyze soft-tissue response of the chin following genioplasty with anterior segmental osteotomy, which enables optimal surgical planning of genioplasty.

METHODS

Sixty-two patients who underwent genioplasty with concomitant anterior segmental osteotomy were divided into three groups depending on the direction of pogonion (Pog) movement: G1 (without sagittal change), G2 (advancement genioplasty), and G3 (setback genioplasty). All genioplasties included height reduction. Hard- and soft-tissue measurements with cephalometry were performed at T1 (before surgery), T2 (after surgery), and T3 (after orthodontic treatment) for the analysis of sagittal and vertical changes. Correlation and regression analyses were conducted to analyze soft- to hard -tissue movement and soft-tissue thickness changes.

RESULTS

During the T1 to T2 period, the horizontal soft- to hard-tissue ratio at Pog was 0.85 in G2 and 0.80 in G3, and the vertical ratio at menton (Me) was 0.9 for all groups. The correlation coefficients were 0.64 (G2) and 0.83 (G3) at Pog and 0.9 (all), 0.85 (G1), 0.95 (G3) at Me. There was no significant correlation between initial soft-tissue thickness and soft-tissue response ratio. During the T2 to T3 period, no significant relapses were observed, which demonstrates the stability of anterior segmental osteotomy combined genioplasty.

CONCLUSIONS

Clinically and statistically significant soft-tissue responses were demonstrated at Pog and Me. The higher values in G3 in particular suggest that setback genioplasty with anterior segmental osteotomy is an effective treatment alternative to conventional two-jaw surgery in some patients with bimaxillary prognathism with macrogenia.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Stability of box genioplasty: a retrospective study

In box genioplasty it is possible to advance, retrude, impact, and elongate, as well as to correct asymmetry. The aim of this study was to analyse the stability of box genioplasty as part of orthognathic correction. Twenty-five consecutive patients who had gone through the multidisciplinary pathway were selected. Menton and pogonion positions on radiographs taken just prior to surgery, and actual surgical movement on three-week and 12-month postoperative cephalograms, were compared. A one-sample Wilcoxon test was applied to assess whether the distributional change in advancement and vertical measurements was equal to zero. After treatment, anteroposterior changes in pogonion and vertical changes in menton were statistically insignificant (p>0.05). Our study demonstrated statistically significant stability of menton and pogonion positions after box genioplasty when surgical movement was only in the symphysis.

Factors affecting progressive facial swelling immediately after orthognathic surgery: A retrospective cohort study

The aim of this study was to identify clinical factors associated with progressive facial swelling after orthognathic surgery. Patients diagnosed with jaw deformities and undergoing orthognathic surgery were retrospectively evaluated, and those with surgical site infection, Le Fort I osteotomy, or genioplasty only were excluded. Facial swelling volume was calculated by comparing facial volume preoperatively and three days postoperatively using 3D images and image analysis software (VECTRA H2). FXIII was measured within three days after surgery in only patients with unexplained postoperative bleeding or hematoma. The correlation between facial swelling volume and clinical factors was statistically analyzed. Facial swelling volume was examined in 78 patients. Univariate analysis showed a significant difference between facial swelling volume (mean = 41.6 cm3) and operation time (mean = 209.3 min, r = 0.283, p = 0.012), ΔHb level (mean = 1.18 g/dL, r = 0.235, p = 0.039), as well as decreased factor XIII activity (mean = 75.3%, p = 0.012). Multivariate analysis showed a significant difference between facial swelling volume and FXIII deficiency (standard error = 6.44, p = 0.031).Progressive facial swelling immediately after orthognathic surgery may be due to factor XIII deficiency.

What factors influence the cost of orthognathic surgery among patients in the US?

OBJECTIVE

The purpose of our study was to analyze what factors influence the cost of orthognathic surgery performed within the US.

STUDY DESIGN

This retrospective cohort study was completed using the Kids' Inpatient Database (KID) from 2000 to 2012 on all patients aged 14 to 20 years who had undergone orthognathic surgery. The predictor variables included patient and hospitalization characteristics. The primary outcome variable was hospital charge ($). Multivariate linear regression was conducted to determine independent predictors for increased/decreased hospital charge.

RESULTS

The final sample consisted of 14 191 patients (mean age, 17.4 ± 1.6 years; females, 59.2%). Each additional day in the hospital added $8123 in hospital charges (P < .01). Relative to mandibular osteotomy, maxillary osteotomy (+$5703, P < .01) and bimaxillary osteotomy (+$9419, P < .01) were each associated with increased hospital charges. Genioplasty (+$3499, P < .01), transfusion of packed cells (TPC) (+$11 719, P < .01), continuous invasive mechanical ventilation (CIMV) <96 hours (+$23 502, P < .01), and CIMV ≥96 hours (+$30 901, P < .01) were each associated with significantly increased hospital charges. Obstructive sleep apnea (OSA) added $6560 in hospital charges (P < .01).

CONCLUSIONS

Maxillary osteotomy and bimaxillary surgery were each associated with significantly increased charges relative to mandibular osteotomy. Concomitant genioplasty, TPC, CIMV, and OSA each significantly increased the charges. Each additional day to the length of stay significantly increased the charges.

Ambulatory sagittal split ramus osteotomy: strategy for enhanced recovery after surgery

The sagittal split ramus osteotomy (SSRO) has been performed mainly on an inpatient basis because of the duration of anaesthesia and the potential risk of postoperative complications, such as bleeding, pain, nausea, and vomiting. However, advances in both surgical and anaesthetic management have enabled the reduction of these risks and shortened the length of hospital stay. Thus, the SSRO may be feasible even in the ambulatory setting in elective cases. The clinical records of all patients who underwent an outpatient SSRO between August 2011 and September 2020 at Lilla Craniofacial Clinic were reviewed retrospectively. Data on age, sex, duration of surgery, operative procedures, intraoperative bleeding, and admission status were investigated. In total, 143 patients underwent a bilateral SSRO. The SSRO was performed as an isolated procedure in 73 patients and concomitantly with other surgical procedures in the remaining 70 patients. Overall, 142 of the 143 patients were discharged on the day of surgery (99.3%); only one (0.7%) required an overnight stay because of a submental haemorrhage after genioplasty. No emergency hospitalizations or readmissions occurred after discharge. Multimodal perioperative management, both surgical and anaesthetic, facilitated enhanced patient recovery after surgery, and SSRO was performed successfully and safely as an ambulatory procedure.

[Surgical treatment of a patient with mandibular micrognathia accompanied by obstructive sleep apnea syndrome using extended genioplasty]

A method for diagnosing, planning and surgical treatment of patients with micrognathia of the mandible with physiological occlusion is proposed, which makes it possible to objectively assess the severity of the anomaly and concomitant functional disorders of external respiration in the nasopharynx and oropharynx, as well as to identify the pathophysiological mechanisms of obstructive sleep apnea syndrome (OSAS) and develop an optimal surgical treatment plan with high functional and aesthetic results.

Retrospective study of long-term hard and soft tissue stability after advancement genioplasty with the use of rigid osteosynthesis

The main objective of this study was to evaluate long-term stability of rigid osteosynthesis in the context of advancement genioplasty. Bone stability was defined as a long-term bone loss of less than 2 mm. Measurements were performed on lateral cephalograms, in the sagittal and vertical planes, at three times: preoperative (T0, less than one month before surgery), early postoperative (T1, at least one month post-operatively) and late postoperative (T2, at least one year after surgery). 25 patients were included in the study, with a mean follow-up of 3.47 years (range 1-9.42 years). The mean sagittal bone advancement at T1 was 4.06 mm ± 1.34, with a bone loss of 0.65 mm at T2 (p = 0.001). The mean vertical bone movement was 1.25 mm ± 0.47 at T1, with a relapse at T2 of 0.34 mm (p = 0.27). The soft-to-hard tissue ratio was 78% in the sagittal plane. Rigid osteosynthesis offers long-term stability, with very little change in clinical outcome, in advanced genioplasty.

Applying Machine Learning to Determine Popular Patient Questions About Mentoplasty on Social Media

PURPOSE

Patient satisfaction in esthetic surgery often necessitates synergy between patient and physician goals. The authors aim to characterize patient questions before and after mentoplasty to reflect the patient perspective and enhance the physician-patient relationship.

METHODS

Mentoplasty reviews were gathered from Realself.com using an automated web crawler. Questions were defined as preoperative or postoperative. Each question was reviewed and characterized by the authors into general categories to best reflect the overall theme of the question. A machine learning approach was utilized to create a list of the most common patient questions, asked both preoperatively and postoperatively.

RESULTS

A total of 2,012 questions were collected. Of these, 1,708 (84.9%) and 304 (15.1%) preoperative and postoperative questions, respectively. The primary category for patients preoperatively was "eligibility for surgery" (86.3%), followed by "surgical techniques and logistics" (5.4%) and "cost" (5.4%). Of the postoperative questions, the most common questions were about "options to revise surgery" (44.1%), "symptoms after surgery" (27.0%), and "appearance" (26.3%). Our machine learning approach generated the 10 most common pre- and postoperative questions about mentoplasty. The majority of preoperative questions dealt with potential surgical indications, while most postoperative questions principally addressed appearance.

CONCLUSIONS

The majority of mentoplasty patient questions were preoperative and asked about eligibility of surgery. Our study also found a significant proportion of postoperative questions inquired about revision, suggesting a small but nontrivial subset of patients highly dissatisfied with their results. Our 10 most common preoperative and postoperative question handout can help better inform physicians about the patient perspective on mentoplasty throughout their surgical course. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Enhanced Submentoplasty as an Adjunct to Orthognathic Surgery for the Improvement of the Neck-Throat Point

Orthognathic surgery has been used to enhance the function of the maxillomandibular complex with numerous positive effects on facial esthetics, as it can profoundly alter the skeletal architecture of the face. Numerous adjunctive surgical techniques are used to enhance the overall cosmetic results of orthognathic surgery to include the following: genioplasty, midface augmentation, rhinoplasty, fillers, and liposuction. Mandibular advancement, submental liposuction and genioplasty are all techniques that help to define the neck throat point (NTP), minimize submental sagging, and enhance throat length (TL) in order to establish a more harmonious facial profile. However, these procedures may still be insufficient to define the NTP in the low hyoid, retrognathic patient. This report presents the case of an adult male, with a non-existent NTP and retrognathia, who underwent corrective orthognathic surgery with the novel enhanced submentoplasty and a suture assisted resuspension of the platysma in order to establish the NTP, increase TL, minimize submental sagging, and enhance mandibular border definition.

First premolar extractions in an adolescent presenting a Class I biprotrusion malocclusion with skeletal Class II: A case report

This case report shows the orthodontic treatment of four first premolar extractions of a 14-year-old teenager presenting a dental Class I malocclusion with a severe retrognathic mandible. It reflects conflicting views on objectives between the orthodontist who takes into account the facial balance and the patient who only desires a tooth alignment.

The intermediate length BSSO: Finding the balance between the classical and short designs

Bilateral Sagittal Split Osteotomy (BSSO) is performed in orthognathic surgery to treat cases of dento-skeletal malformation. We present a shorter BSSO variant that allows for the realization of all orthognathic movements. This line respects the basilar rim and allows to modify the position of the mandibular angles. The splitting is more natural, separating the mandible into two anatomical subunits: the rising branch and the horizontal branch. This variant layout may also be associated with Chin Wing genioplasty.

Assessment of the Effect of Simulated Rhinoplasty and Genioplasty on the Facial Profile Attractiveness of Patients with a Convex Face

AIM

This study was performed to evaluate the effect of rhinoplasty and genioplasty on facial profile attractiveness assessed by orthodontists and laypersons.

MATERIALS AND METHODS

In this study, posttreatment cephalo-grams of 30 class II patients with convex profile and nasal hump who had undergone camouflage treatment were traced. These profile outlines were modified by computer software to simulate rhinoplasty and genioplasty. Then, all these outlines were converted into silhouettes. There were four groups: no modification, rhinoplasty (R), genioplasty (G), and rhinoplasty plus genioplasty (RG). Esthetic assessment of all patients was done by two panels: six orthodontists and six laypersons. Data were analyzed using Friedman's and Wilcoxon's test with a significance level of 0.05.

RESULTS

The highest mean esthetics scores belonged to RG (3.9 ± 0.6), followed by R (3.5 ± 0.5), G (2.4 ± 0.5), and the initial image of the patients (2.13 ± 0.5). There was a significant improvement following all surgeries as determined by all evaluators (p < 0.001), except for orthodontists who did not find genioplasty more esthetic than no modification (p = 0.139). The mean score of esthetics by orthodontists was more than laypersons in all groups (p > 0.05).

CONCLUSION

Both rhinoplasty and genioplasty improved the attractiveness of the patients' facial profiles. The greatest improvement in the facial profile attractiveness in convex faces was observed after simultaneous nasal hump elimination and chin argumentation procedures.

CLINICAL SIGNIFICANCE

Although both rhinoplasty and genioplasty could improve patients' profile, the best result is achieved when combination of them is used for treatment of convex facial profile patients.

Where to position osteotomies in genioglossal advancement surgery based on locations of the mental foramen, canine, lateral incisor, central incisor, and genial tubercle

PURPOSE

The study aimed to provide precise measurements of anterior mandibular structural anatomy and to explore potential osteotomies for genioglossal advancement.

METHODS

Cone beam computed tomography was used to analyze 33 randomly selected patients undergoing surgery for obstructive sleep apnea (OSA) between 2014 and 2016 at an academic surgical hospital. The locations of relevant mandibular structures were measured and statistical modeling was performed.

RESULTS

Mean horizontal distances from midline to the mental foramina and the roots of the canine, lateral incisor, and central incisor were 22.11 ± 1.92, 13.56 ± 3.01, 6.19 ± 1.58, and 2.04 ± 0.87 mm, respectively. Mean vertical distances from the inferior border of the mandible were 15.15 ± 1.77, 17.11 ± 3.28, 20.48 ± 3.10, and 21.81 ± 3.49 mm, respectively. The superior border of the genial tubercle was 15.63 ± 2.75 mm, and the inferior border was 6.87 ± 3.29, from the inferior border of the mandible. The angle of decline of the best-fit line through the important structures was about 18° from the occlusion plane at the midline.

CONCLUSIONS

A straight line estimating the mental foramen, canine, lateral incisor, and central incisor tooth roots crosses at a mean of 22.3-22.6 mm above the inferior border of the mandible at the midline and has an angle of decline of about 18°. Potential osteotomies made parallel to and below this line result in tradeoffs between maximizing capture of the genioglossus muscle attachment and risk of dental/neurovascular injury.

[Evaluation of profile aesthetics of skeletal Class Ⅱ patients with different treatment methods]

PURPOSE

To study the aesthetic appearance of skeletal Class Ⅱ patients with maxillary protrusion and mandibular retrusion treated with different methods.

METHODS

The facial profile photographs and lateral cephalometric radiographs of a Chinese woman suffering from skeletal Class Ⅱ with maxillary protrusion and mandibular retrusion was digitized.The digital images were modified to obtain orthodontic compensatory treatment, genioplasty with different advancement ranges and orthognathic treatment comprising 6 profiles by Photoshop software，orthodontic professionals and non-professionals were chosen to score the pictures. Post hoc tests were done with ANONA and the Student Keuls method to analyze the data Using SPSS22.0 software package.

RESULTS

The profile with the highest score was the picture treated by orthognathic and orthodontic treatment. The profile with genioplasty (advancement of 4 mm) took the second place. When the advancement distance of genioplasty was 8 mm, the score was under the score of orthodontic compensatory treatment profile.

CONCLUSIONS

Orthognathic-orthodontic treatment of skeletal Class Ⅱ is still the best treatment option to improve facial aesthetics. Genioplasty, as a adjuvant treatment, improves the appearance based on compensatory orthodontic treatment to some extent, but not comparable to orthognathic-orthodontic treatment.

Operative time, blood loss, hemoglobin drop, blood transfusion, and hospital stay in orthognathic surgery

PURPOSE

This study was conducted to evaluate the operative time, blood loss, hemoglobin drop, blood transfusion, and length of hospital stay in orthognathic surgery.

METHODS

A 10-year retrospective analysis was performed on patients who underwent bilateral sagittal split osteotomy (with or without genioplasty), Le Fort I osteotomy (with or without genioplasty), or any combination of these procedures. A total of 271 patients were included.

RESULTS

The age range was 17 to 49 years, with a mean age of 24.13 ± 4.51 years. Approximately 62% of patients underwent double-jaw surgery. The most common procedure was bilateral sagittal split with Le Fort I (37%). The average operative time was 3.96 ± 1.25 h. The mean estimated blood loss was 345.2 ± 149.74 mL. Approximately 9% of patients received intraoperative blood transfusion. The mean hemoglobin drop in the non-transfusion cases was 2.38 ± 0.89 g/dL. The mean postoperative hospital stay was 1.85 ± 0.83 days. Only one patient was admitted to the ICU for one night.

CONCLUSIONS

In orthognathic surgery, blood loss is relatively minor, blood transfusion is frequent, and ICU admission is unlikely. Operative time, blood loss, blood transfusion, and the complexity of the surgical procedure can significantly increase the length of hospital stay. Males may bleed more than females in orthognathic surgery. Hemoglobin drop can be overestimated due to hemodilution in orthognathic surgery, which may influence the decision to use blood transfusion.

Changes in natural head position in response to mandibular advancement

We investigated the change in the natural head position and its relation to the change in the mandibular position in patients with mandibular hypoplasia. Forty-one patients treated by orthognathic surgery were divided into three groups: bilateral sagittal split osteotomy (BSSO) advancement (n=8); BSSO advancement with genioplasty (n=12), and Le Fort I osteotomy with BSSO advancement (n=21). Cone-beam computed tomographic (CT) datasets were collected preoperatively and six weeks postoperatively. The natural head position was measured using the craniocervical angle and the distance from the second vertebra to the frontal plane, and the mandibular position was measured using the craniomandibular angle and the distance from the mandible to the frontal plane. Repeated measures two way ANOVA was used to assess the significance of differences between the angular and linear measurements, and Pearson's correlation coefficient to assess those between the change in the mandibular position and the natural head position. The craniomandibular angle increased and the mandible to frontal plane distance decreased, as planned; the craniocervical angle increased, and the distance from the second vertebra to the frontal plane decreased in all three groups. ANOVA showed a significant difference in the time factor (preoperative compared with postoperative) but no significant differences between the groups or interaction (time multiplied by group) factors. There was a significant correlation between the change in mandibular position and the change in the natural head position. Changes in the natural head position after correction of mandibular hypoplasia are correlated with the change in the mandibular position, regardless of whether a genioplasty or Le Fort I osteotomy was done.

[Clinical application of condylectomy via intraoral approach under computer assisted surgical navigation]

OBJECTIVE

To assess the application of computer assisted surgical navigation in condylectomy via intraoral approach and its clinical results.

METHODS

Eight patients aged from 16 to 56 were treated by condylectomy via intraoral approach under computer assisted surgical navigation. There were 6 female and 2 male. The lesions were condyle osteoma in 3 patients, hemimandibular hyperplasia and condylar hyperplasia in 5 patients. Most patients had concomitant LeFortIosteotomy (6 cases), bilateral sagittal split ramus osteotomy (BSSRO) (5 cases),contralateral sagittal split ramus osteotomy (SSRO) (1 cases), genioplasty (4 cases) and mandible contouring (6 cases) to recover the facial symmetry.

RESULTS

All patients had good occlusion, oral function and facial symmetry after the operation. The average mouth opening was 38 mm before operation, and 41 mm one month after operation. The temporomandibular joint(TMJ) dysfunction syndrome alleviated or disappeared. The follow-up period was 3-12 months, and results were stable.

CONCLUSIONS

Computer assisted surgical navigation can precisely accomplish the condylectomy via intraoral approach.It causes less trauma to the patient than traditional condylectomy, and can better preserve the TMJ structure and function.

Closure of anterior open bites with mandibular surgery: advantages and disadvantages of this approach

INTRODUCTION

While closure of an anterior open bite with a mandibular procedure may predispose a surgical case to instability, there are instances where this type of treatment planning is indicated.

METHODS AND MATERIALS

In this paper, the authors review the advantages and disadvantages of this approach and present three cases with varying degrees of success. Additionally, treatment strategies are presented for managing large advancements of the maxilla and mandible.

RESULTS AND SUMMARY

Counterclockwise rotation of the mandible is a valuable tool that can be used in the treatment of patients with dentofacial deformities.

[Management of labial incompetence and gummy smile using profiloplasty]

INTRODUCTION

Gummy smile and labial incompetence are frequent for consultation in plastic surgery. We wanted to show that rhinoplasty and genioplasty should correct these anomalies.

PATIENTS AND METHODS

Profiloplasty was performed on 20 patients. Aesthetic and functional items were evaluated.

RESULTS

There is a correlation between aesthetic and functional results. Results seem to be better for patients having an important labial incompetence without gummy smile.

CONCLUSION

Those results are based on anatomical and surgical considerations. Some non surgical procedures do exist to treat this problem. It should be a challenge to find the place for each procedure.