Preoperative Radiology and Virtual Surgical Planning

Virtual surgical planning enables precise surgical planning and translation of this planning into the operating room. Preoperative maxillofacial computed tomography scans are compared to a reference skull to identify desired surgical changes. In facial feminization surgery, these include forehead recontouring/frontal table setback, gonial angle reduction, and possible chin repositioning/reshaping, while in facial masculinization surgery, this includes forehead augmentation and gonial angle/chin augmentation. Cutting and recontouring guides as well as custom implants are then custom manufactured. Common guides include osteotomy guides, depth drilling guides, ostectomy guides, and guides for one/two-piece genioplasty or chin burring. Common implants include mandibular and chin implants.

Validation of a fully automatic three-dimensional assessment of orthognathic surgery

The aim of the present study was to propose and validate FAST3D: a fully automatic three-dimensional (3D) assessment of the surgical accuracy and the long-term skeletal stability of orthognathic surgery. To validate FAST3D, the agreement between FAST3D and a validated state-of-the-art semi-automatic method was calculated by intra-class correlation coefficients (ICC) at a 95 % confidence interval. A one-sided hypothesis test was performed to evaluate whether the absolute discrepancy between the measurements produced by the two methods was statistically significantly below a clinically relevant error margin of 0.5 mm. Ten subjects (six male, four female; mean age 24.4 years), class II and III, who underwent a combined three-piece Le Fort I osteotomy, bilateral sagittal split osteotomy and genioplasty, were included in the validation study. The agreement between the two methods was excellent for all measurements, ICC range (0.85-1.00), and fair for the rotational stability of the chin, ICC = 0.54. The absolute discrepancy for all measurements was statistically significantly lower than the clinical relevant error margin (p < 0.008). Within the limitations of the present validation study, FAST3D demonstrated to be reliable and may be adopted whenever appropriate in order to reduce the work load of the medical staff.

Does Aesthetic Osseous Genioplasty Impact Upper Airway Volume?

BACKGROUND

Although maxillomandibular advancement is the treatment of choice for obstructive sleep apnea syndrome (OSAS) in the presence of underlying maxillomandibular complex hypoplasia, there is still a gap in the literature regarding the impact of genioplasty upon upper airway volume (UAV).

OBJECTIVES

The aim of this study was to evaluate the impact of isolated osseous genioplasty upon UAV.

METHODS

A retrospective analysis of all patients subjected to isolated osseous genioplasty between July 2015 and July 2022 was conducted. Cone-beam computed tomography was performed preoperatively and postoperatively to assess the chin and hyoid 3-dimensional (3D) spatial position and UAV changes after surgery.

RESULTS

A total of 44 patients were included in the study. Regarding surgical movements of the chin, almost all patients received a sagittal movement (n = 42; 39 forward and 3 backward), while in 8 patients a vertical movement (5 upward and 3 downward) was applied, and in 6 patients the chin was centered. Statistically significant increases in total UAV (P = .014) and at the level of the oropharynx (P = .004) were observed. Specifically, chin centering, upward and forward movements enlarged the oropharynx volume (P = .006, .043 and .065, respectively). Chin advancement enlarged the hypopharynx volume (P = .032), as did upward movement of the hyoid bone (P < .001).

CONCLUSIONS

Results of the study suggest that aesthetic osseous genioplasty impacts the UAV: each 3D spatial chin movement differently impacts the upper airway by enlarging or narrowing it. However, further studies addressing the apnea-hypopnea index are required to assess its effectiveness in treating OSAS.

LEVEL OF EVIDENCE: 4

Osseous genioplasty versus chin implants: early complications and patient satisfaction

Osseous genioplasty and chin augmentation with implants are the two main treatment options for retrognathia. This retrospective cohort study was performed to compare the prevalence of complications and patient satisfaction following osseous genioplasty and chin augmentation by implant. Eighty patients were included: 38 underwent advancement osseous genioplasty and 42 received chin implants (alloplastic, either Medpor or Silastic) intraorally or extraorally. The patients were assessed for complications 12 months after surgery, including neurosensory disturbances, infection or extrusion, wound dehiscence, and the need for reoperation. Patient satisfaction was evaluated using a visual analogue scale. The infection rate was significantly higher in the chin implant group than in the genioplasty group (P = 0.028). Moreover, dehiscence and the need for reoperation appeared to be more common following chin augmentation with implants. However, there was no significant difference in the prevalence of neurosensory disturbances between the two groups (P = 0.137). In the chin implants group, the extraoral approach resulted in a lower dehiscence rate than the intraoral approach. Patients in the genioplasty group had significantly higher satisfaction scores than those in the chin implant group (P = 0.001). Overall, the rates of the complications assessed were lower and patient satisfaction was higher after osseous genioplasty when compared to chin augmentation with implants.

Minimally invasive genioplasty: an observational study

PURPOSE

This study aimed to determine the feasibility of a minimal invasive genioplasty (MIG) technique combining a limited vertical incision, endoscopy, and a piezotome.

METHODS

A total of thirteen patients who underwent primary genioplasty procedures under general anesthesia were evaluated. The feasibility of the method was reported in terms of total surgery time, the total amount of intra-operative blood loss, neurosensory dysfunction, pain sensation, infection, and patient satisfaction using the FACE-Q Chin scale.

RESULTS

We observed the mean surgery time of 46.08 ± 5.33 min with a statistically significant p-value of 0.157. The ANOVA test value for mean neurosensory testing score (NST) was calculated as 5.95 (p = 0.006) for the right side and 7.64 (p = 0.017) for the left side. The paired t-test value of the mean pain score was 117.98 (p < 0.001) and showed no significant pain after 1 week. The quality of the osteotomy was deemed good in 12 patients with less intra-operative blood (ranged from 7.7 to 46.2%).

CONCLUSION

Based on these results, this minimally invasive technique for genioplasty is a promising approach to perform a chin osteotomy and should be an alternative to the conventional genioplasty technique.

A novel guide for minimally invasive genioplasty

Mentoplasty or genioplasty is a simple procedure to enhance facial aesthetics. While usually considered simple, it might present certain difficulties during execution, especially when a minimally invasive approach is preferred. Drilling and cutting guides are a valuable tool to overcome such challenges but usually require larger incision and dissection to allow adequate positioning and bone rigid fixation. In this article, we describe a novel guide design that permits adequate bone repositioning while preserving minimally invasive protocols.

The Versatile Role of Fat Injection During Various Genioplasties

BACKGROUND

Fat injection has become increasingly popular in aesthetic surgery, but there is a sparsity of literature regarding its role during genioplasty. In this study, we present the largest series of patients receiving fat injections to the chin for various indications.

METHODS

Data were collected from January 2016 to December 2021 for patients who underwent chin fat injection for a variety of chin refinements. Patients with chin fat injection were divided into isolated genioplasty with fat injection (CF), combined facial and chin fat injection (CFC) and combined chin fat injection and osseous genioplasty (CFG). Complication rates and reoperations were compared using Fischer's exact test between each cohort.

RESULTS

181 patients were included in final analysis, with 14 patients in CF cohort, 130 patients in CFC cohort, 24 patients in CFG cohort, and 13 patients who underwent genioplasty alone. Repeat fat injections were required in 17 (9.4%) patients overall, which included 14 patients (10.8%) of CFC subcohort and three patients (12.5%) of CFG subcohort (p > 0.05). No patients who underwent genioplasty alone or CF required reoperation. There were no significant differences in complications between genioplasty alone group (0%) in comparison to CF (7.1%; p = 1.00), CFC (6.2%; p = .53), or CFG cohorts (7.7%; p = 1.00).

CONCLUSION

Fat injection can safely correct minor chin deficiency or asymmetry, as either an isolated procedure or in combination with osteotomies. Additionally, fat injection enables advancement of the caudal segment to achieve superior outcomes by preventing unaesthetic deepening of labiomental groove which will not be advanced during sliding osteotomy.

LEVEL OF EVIDENCE IV

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 .

Readmission after orthognathic surgery

OBJECTIVE

To evaluate the readmission rate after orthognathic surgery and identify associated risk factors.

STUDY DESIGN

Retrospective analysis of patients who underwent orthognathic surgery and had an unexpected hospital admission, with or without return to the operating room (OR), within the first postoperative year. Study variables included sex, age, American Society of Anesthesiologists (ASA) status, type of surgery, concomitant third molar extraction, concomitant genioplasty, duration of surgery, first assistant experience, and duration of hospitalization. Bivariate associations were calculated between variables and readmission status. Chi-square and Fisher's Exact tests were used to compare categorical variables, and a 2-sample t test was used to compare continuous variables.

RESULTS

There were 701 patients included in the study. The readmission rate was 9.70%. Twelve patients were managed non-surgically, and 56 patients required an OR procedure. The most common reason for readmission without return to the OR was an infection, and for reoperation was hardware removal. Age, sex, type of surgery, third molar extraction, genioplasty, duration of surgery, and experience of first assistant were not found to be predictors for readmission.

CONCLUSIONS

Only ASA classification and duration of initial hospitalization were significant risk factors for readmission of patients within the first postoperative year after orthognathic surgery.

Digital template-guided genioplasty for patients with jaw deformity resulting from temporomandibular joint ankylosis: A comparison between single- and double-layer genioplasty

The aim of this study was to compare single- and double-layer digital template-assisted genioplasty for the correction of jaw deformity resulting from temporomandibular joint ankylosis (TMJA). Thirteen patients with jaw deformity resulting from TMJA who underwent lateral arthroplasty, costochondral graft, or total joint replacement combined with single- or double-layer digital template-assisted genioplasty were included. Computed tomography data were obtained for the preoperative design. Digital templates were designed and manufactured using three-dimensional printing to assist with the chin osteotomy and repositioning in single- or double-layer genioplasty. Of the 13 patients included, seven underwent single-layer genioplasty and six underwent double-layer genioplasty. The digital templates precisely reflected the osteotomy planes and repositioning of the chin segments intraoperatively. The radiographic evaluation showed that the patients who underwent double-layer genioplasty exhibited more chin advancement (11.95 ± 0.92 mm vs 7.50 ± 0.89 mm; P < 0.001) with a slightly larger mean surface error (1.19 ± 0.14 mm vs 0.75 ± 0.15 mm; P < 0.001) than those who underwent single-layer genioplasty. This indicates that double-layer genioplasty better promoted chin advancement and improved the facial shape, but was accompanied by more surgical error compared with the preoperative design. Furthermore, hardly any nerve damage was observed. Digital templates are useful for assisting in surgical procedures.

Aesthetic Genioplasty Based on Strategic Categorization

BACKGROUND

Genioplasty is a popular procedure used for lower facial contour correction. Various osteotomy techniques enable us to perform advancement, setback, reduction, or narrowing procedures. Computed tomographic images facilitate preoperative planning in detail. The authors used a novel planning method based on strategic categorization. The analytic results are described.

METHODS

This retrospective study reviewed 208 patients who underwent genioplasty procedures for facial contouring from October of 2015 to April of 2020. During preoperative evaluation of the mandible, the operative procedure selected was one of three types: (1) horizontal segment osteotomy, (2) vertical and horizontal segment osteotomy, and (3) bone graft after repositioning. Adequate osteotomies were followed by rigid fixation using a titanium plate and screws. The follow-up period ranged from 8 to 24 months (average, 17 months). The results were assessed based on medical records, photographs, and facial bone computed tomographic images.

RESULTS

Overall, the patients were satisfied with the outcomes and had responder-based improvement in lower facial contour and balance. Chin point deviations were noted in 176 cases; left-side deviation ( n = 135) was more frequent than right-side deviation ( n = 41). Strategic osteotomies based on precise measurements led to correction of asymmetries. Temporary partial sensory losses reported in 12 cases resolved within an average of 6 months after surgery.

CONCLUSIONS

Each patient's chief complaint and bony structures should be carefully evaluated before genioplasty procedures are performed. During the operation, meticulous osteotomy, precise movement, and rigid fixation are necessary. The strategic process used for genioplasty resulted in aesthetic balance and predictable outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Bone healing and stability after advancement genioplasty using a pre-bent absorbable plate and screws

This study aimed to compare the bone healing and stability of the chin with a pre-bent absorbable plate and a manually bent absorbable plate after advancement genioplasty. Patients with class II malocclusion who underwent genioplasty with bimaxillary surgery were included. After genioplasty, two absorbable bicortical screws were fixed on both sides. Then, a pre-bent absorbable plate and screws were used in the center area to fix the segment in advancement genioplasty (PB group). A manually bent absorbable plate was used for the remaining patients (MB group). Computed tomography (CT) was performed before surgery and 1 week and 1 year after surgery. Changes in the pogonion (Pog) and menton (Me) points, soft tissue points, and the ratio of bone squares under the plate were evaluated using lateral cephalometric images reconstructed with 3-dimensional CT data. 32 patients were included in the study. There were no significant differences in the cephalometric measurements in the time interval from 1 week to 1 year. However, the bone square ratio in the PB group showed a significant increase after 1 year (P = 0.0021). Within the limitations of the study it seems that the use of a pre-bent absorbable plate is effective in promoting bone healing after advancement genioplasty.

Autoimmune diseases and orthognathic surgery: A case series of 12 patients

Autoimmune diseases result from the immune system attacking native cells and tissues due to the recognition of "self" antigens as foreign antigens. This group of disorders is associated with an increased risk of complications after surgical interventions, as the immune system may cause tissue destruction. The study aimed to investigate the risk of surgical complications in patients with autoimmune diseases, who are at a higher risk of complications due to their condition. Among 886 patients who underwent orthognathic surgery, twelve types of autoimmune diseases with 22 patients were identified. For this case-series study, 12 patients were selected with a follow-up period of at least two years. The surgical procedures were executed by a single surgical team, which involved single or multi-piece Le Fort I osteotomy, Hunsuck/Epker modification of bilateral sagittal split osteotomy (BSSO), and/or genioplasty. The recorded outcome variables were postoperative adverse events, including respiratory or blood-related complications, wound infection, neurosensory disturbances, temporomandibular joint (TMJ) complications, and relapse. Only two patients recovered after surgery without any postoperative complications, whereas others had delayed recovery from neurosensory disturbance (5/12), infection (5/12), TMJ complications (2/12), and other complications. The findings of this study suggest that patients with autoimmune diseases undergoing orthognathic surgery are at higher risk of complications, highlighting the importance of careful consideration of patient selection and risk stratification before surgical intervention. The study also emphasizes the importance of close postoperative follow-up to detect and manage complications promptly.

[Three-dimensional comparative study on the stability of bimaxillary simultaneous genioplasty and simple genioplasty]

PURPOSE

To establish a three-dimensional method to evaluate whether there is a difference in stability between bimaxillary simultaneous genioplasty and simple genioplasty.

METHODS

This study was a retrospective study. Sixty patients who underwent genioplasty were selected. They were divided into bimaxillary simultaneous genioplasty group (n=30) and simple genioplasty group (n=30). The spiral CT data of patients at 2 months before operation (T0), 7 days after operation (T1) and 12 months after operation (T2) were collected, reconstructed and separated, and the three-dimensional model of maxilla and mandible was obtained. A three-dimensional analysis method of stability was established by 3D-matching. Recurrences in three-dimensional space 12 months after surgery were analyzed in two groups of patients. Statistical analysis of the data was performed with SPSS 26.0 software package.

RESULTS

In simple genioplasty, the maximum amount of the chin recurrence was sagittal backward recurrence (0.54±0.38) mm, and the sagittal recurrence rate was 12.27%. In bimaxillary simultaneous genioplasty, the maximum amount of the chin recurrence was sagittal backward recurrence (0.60±0.31) mm, and the sagittal recurrence rate was 12.96%. Rotation occurred in both groups 12 months after operation, which was 1.98±2.70° in the simple genioplasty group and 1.01±1.61° in the bimaxillary simultaneous genioplasty group(P＜0.05). There was no significant difference in the sagittal movement of the chin between the two groups, and in the sagittal recurrence(P＞0.05).

CONCLUSIONS

The three-dimensional method established in this study can be used to evaluate the stability after genioplasty. The recurrence after genioplasty mainly occurred in the sagittal direction. The rotation trend of chin after genioplasty is worthy of attention. There was no increased risk for bimaxillary simultaneous genioplasty.

Evaluation of trabecular changes following advancement genioplasty combined with or without bilateral sagittal split osteotomy by fractal analysis: a retrospective cohort study

BACKGROUND

It is aimed to investigate whether there was a difference in radiographic changes in the operational areas between genioplasty alone and genioplasty combined with mandibular advancement and to evaluate the fractal dimension (FD) to assess trabecular changes after genioplasty surgery.

METHODS

Preoperative-(T0) and postoperative-(T1) panoramic radiographs of 26 patients without any complications who underwent genioplasty combined with bilateral sagittal osteotomy and mandibular advancement or genioplasty alone were selected. In the panoramic radiographs of both groups, the genial segment, mandibular angulus, and surgical osteotomy line were examined using FD. The box-counting method was used for FD evaluation.

RESULTS

It was determined that FD values before and after treatment were similar in both groups for all regions where measurements were made. After surgery, the FD values of the middle region of the genial segment were found to be significantly lower than the other regions. At T1, the FD values at the osteotomy area were found to be significantly higher than those in the middle region of the genial segment.

CONCLUSION

Trabecular structure does not differ in patients undergoing genioplasty alone or in combination with mandibular advancement osteotomy. The middle region of the genial segment heals later than other regions.

Sagittal reduction genioplasty: Technical note

Without a doubt, the chin plays an important role on facial harmony. Both position and shape of the chin can significantly affect the facial profile. Genioplasty is a relatively simple surgical procedure that allows to correct deformities associated to the chin area. Several techniques and modifications have been described in the literature for different types of deformities. Anterior posterior reduction osteotomies of the chin have an unpredictable effect on the soft tissues and the use of the conventional sliding osteotomy have shown unsatisfactory cosmetic outcomes, this associated with step deformity, notching at the inferior border of the mandible among others. We propose a simple and effective technique that allows the correction of a chin deformity in cases where sagittal or vertical reduction is required with excellent esthetic results. Four case examples are presented for technique illustration.

[Assessment of soft-tissue vs hard-tissue changes after isolated functional genioplasty]

INTRODUCTION

This study aimed to determine the vertical and horizontal soft-tissue vs hard-tissue changes after isolated functional genioplasty and to revisit hard-tissue remodeling at the symphysis.

METHODS

Seventy-five patients who underwent genioplasty as an isolated procedure at the end of their orthodontic treatment were divided into three groups on the basis of their age at surgery: < 15 years (group 1), 15-18 years (group 2) and ≥ 19 years (group 3). Patients were evaluated at three time points: immediately before surgery (T1), immediately after surgery (T2) and two years after surgery (T3). In addition, 25 patients who did not accept genioplasty, were age-matched with group 1, and had a follow-up radiograph two years after the end of their orthodontic treatment were used as a control group.

RESULTS

From T2 to T3, group 1 showed less forward horizontal hard-tissue and soft-tissue changes at pogonion (Pg) than the control group; however, no difference was noted for vertical changes at Me & Me’. From T1 to T3, the horizontal hard-tissue and soft-tissue changes at Pg were 6.39 mm and 6.72 mm, respectively, for surgical groups. Vertical hard-tissue change at menton (Me) showed a reduction of 1.63 mm (95% confidence interval [CI], -3.37 to 0.11) and 3.89 mm (95% CI, -5.83 to -1.95) in nongrowing female and male patients, respectively. The vertical soft-tissue change reduction was similar for nongrowing male and female patients (1.7 mm [95% CI, -2.96 to -0.45]). Soft-tissue thickness change at Pg (0.33 mm) was not significant. In contrast, a small but significant increase in soft-tissue thickness was noted at Me (0.54 mm). Linear regressions were calculated for all groups and allowed for predicting long-term soft-tissue changes (T3-T1) using the amount of surgical displacement (T2-T1).

CONCLUSIONS

The horizontal hard-tissue change was stable for nongrowing patients, and the horizontal soft-tissue change was 92% of hard-tissue. Vertical soft-tissue change is less predictable. Variation of soft-tissue thickness after genioplasty can be explained by skeletal changes and the achievement of an unforced labial occlusion. These results support the functional and esthetic benefits of this surgery. Comparison with the control group showed that genioplasty does not change the growth pattern, and bone remodeling is likely to explain the difference noted at Pg.

[The 3D-printed surgical guides used during genioplasty]

Genioplasty is a seemingly simple procedure performed to correct the bony chin. The results of the procedure are, however, strongly correlated with the experience of the surgeon. 3D-printed surgical guides could act as a transfer modality to translate the preoperative planning directly into the achieved result. Prospective studies evaluating the usefulness of the 3D-printed surgical guides have not yet been carried out and consensus regarding the best design is lacking. In order to become more familiar with working with surgical guides, a genioplasty using 3D-printed surgical guides was performed. The postoperative analysis of the achieved result showed minor differences compared to preoperative planning. Surgical guides have the potential to improve the accuracy and predictability of genioplasty. The design should be further refined and the added value of the guides should be confirmed by means of prospective research.

Long-term hard and soft tissue response following isolated genioplasty: a systematic review

PURPOSE

Genioplasty facilitates alteration of the chin position and contour which contributes to aesthetics and function. The response of the hard and soft tissues following genioplasty has not been assessed after a year or more of the surgery being performed. Hence, the aim of this systematic review was to assess the response of the hard and soft tissues occurring at least 1 year after the procedure.

MATERIAL AND METHODS

A literature search was conducted in the following electronic databases: PubMed, Ovid, LILACS, and Cochrane Library. Potential articles were identified wherein only studies with genioplasty performed as an isolated procedure and with data at least 12 months after the procedure were included.

RESULTS

Five studies were included in this systematic review. Two of the articles included were considered to be of good quality while three were considered to be of moderate quality using a modified Downs and Black tool. The ROBINS-I tool showed a moderate risk of bias for most domains. The study characteristics revealed varying degrees of relapse for the hard and soft tissues.

CONCLUSIONS

In the anteroposterior plane, the soft tissue relapsed more than the hard tissues 3 years post genioplasty. However, relapse in the vertical plane showed a wide variation for both the hard and soft tissues. In the anteroposterior plane, the hard tissue to soft tissue response 2 years or more following genioplasty ranged from 1:0.77 to 1:0.91 while in the vertical plane the hard tissue to soft tissue response ranged from 1:0.67 to 1:1.16.

Total inferior border ostectomy versus T-shape genioplasty for chin narrowing combined with mandibular contouring

The objective of this study was to compare the indications and outcomes of the total inferior border ostectomy and T-shape genioplasty. A retrospective study was conducted using the clinical notes and records of patients who underwent total inferior border ostectomy (group 1, n = 42) and T-shape genioplasty (group 2, n = 60). The outcomes were evaluated by assessment of computed tomography images combined with medical records and photographs. Lower facial height, chin width, chin symmetry, and facial proportions, as well as patient satisfaction and complications were investigated. The data were collected preoperatively and 6-24 months postoperatively. All 102 patients showed an improved lower facial contour. No severe complications were observed during the follow-up period. Although the postoperative lower to midfacial height ratios were similar in the two groups (P = 0.080), both the preoperative and postoperative chin width to lower facial height ratios were lower in group 1 (both P < 0.001). A larger amount of chin narrowing, as well as better chin symmetry were observed in group 1 (P < 0.001). In conclusion, compared to the T-shape genioplasty, the total inferior border ostectomy is well suited for a longer, wider, and more asymmetrical chin. The surgical options should be considered and chosen quantitatively to achieve aesthetically pleasing results.

Accuracy of Self-designed 3D-Printed Patient-Specific Surgical Guides and Fixation Plates for Advancement Genioplasty<<<<<<

AIM

We conducted a prospective study to evaluate the accuracy and complications of 3D-printed patient-specific surgical guides and plates that were designed and finished in-house.

MATERIALS AND METHODS

Eighteen patients who required advancement genioplasty, with or without concomitant orthognathic surgery, were enrolled in the study. Virtual surgical movements were simulated using the patients' cone-beam computed tomography (CBCT) scans, and computer-aided designing of patient-specific surgical guides and fixation plates were performed in our department. CBCT scans were taken at 1 month postoperatively, stereolithographic models of the preoperative virtual plan and the postoperative CBCT were registered. Part comparisons were done to assess the accuracy of the movements. The median, minimum and maximum differences were measured. Two landmarks, the Menton and Pogonion, were also used to compare the differences locally.

RESULTS

The median deviations for the 18 cases was 0.19mm. The median deviation at the Menton and Pogonion were 0.67mm and 0.41mm respectively. There was no significant correlation between the surgical movement of less than 7mm advancement and the transfer accuracy (p = 0.77). No adverse events or complications were reported within post-operative 6 months.

CONCLUSIONS

Our protocol of self-designed 3D-printed patient-specific surgical guides and plates provided an accurate method to transfer the virtual surgical plan to the operating theatre.

A New Concept of Narrowing Genioplasty: Home Plate-Shaped Sliding Osteotomy

BACKGROUND

Narrowing genioplasty is commonly performed among East Asian populations, as a broad and/or square chin can be aesthetically unappealing. This study was aimed to introduce the home plate-shaped sliding osteotomy technique for narrowing genioplasty and to evaluate the results of this technique.

METHODS

A retrospective chart review of 117 patients who underwent home plate-shaped sliding osteotomy alone between 2011 and 2019 was performed. The angles of oblique osteotomy lines and measurements of caudal repositioning, which significantly affect the postoperative chin shape, were evaluated.

RESULTS

The home plate-shaped sliding osteotomy technique was successfully accomplished for narrowing genioplasty as an isolated procedure. The mean distance of caudal repositioning was 3.9 ± 0.8 mm, and the mean angles of oblique osteotomy lines were 23.3 ± 4.8 degrees on the right and 21.8 ± 3.5 degrees on the left. This produced an aesthetically pleasing rounded and proportionately narrow chin. The incidence of minor complications was 6.0 percent. There were no major complications. In particular, the risk of inferior alveolar nerve injury was obviated, as an additional mandibular border osteotomy was not typically used with this technique.

CONCLUSIONS

This new surgical procedure for narrowing genioplasty provides improved aesthetic results by altering the chin shape, rather than reducing the transverse width of the chin. The versatility of this procedure allows the chin shape to be adjusted with respect to narrowing, vertical lengthening, anterior advancement, and asymmetric or cleft chin correction. The present study suggests that home plate-shaped sliding genioplasty may be an excellent alternative for correcting broad and/or square chins and more complex chin deformities.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Preliminary clinical experience of robot-assisted surgery in treatment with genioplasty

Genioplasty is the main way to treat diseases such as chin asymmetry, dysplasia and overdevelopment, which involve the three-dimensional direction abnormalities of the chin. Since this kind of surgery mainly uses intraoral incisions, the narrow surgical field of intraoral incisions and the surrounding important neurovascular tissues make it easy for complications, to occur during the osteotomy process, which results in greater surgical risks. The first craniofacial-plastic surgical robot (CPSR-I) system is developed to complete the precise positioning and improve the surgeon's force perception ability. The Kalman filtering method is adopted to reduce the interference of sensor signal noise. An adaptive fuzzy control system, which has strong robustness and adaptability to the environment, is designed to improve the stability of robot-assisted surgical operations. To solve the problem of the depth perception, we propose an automatic bone drilling control strategy that combines position and force conditions to ensure that the robot can automatically stop when the bone is penetrated. On the basis of model surgery and animal experiments, preliminary experiments were carried out clinically. Based on the early results of 6 patients, the robot-assisted approach appears to be a safe and effective strategy for genioplasty.

Face-neck lifting and ancillary procedures: A series of 203 cases

Various methods and ancillary procedures have been defined in the era of face-lifting surgery.The purpose of this study was to evaluate the esthetic outcomes of our face-neck cases and the importance of adding ancillary procedures based on individual assessment.We conducted a retrospective review of 203 face-neck cases, basically following the endoscopic and open principles of Vasconez. The ancillary procedures added in selected cases included genioplasty, augmentation with autologous facial superficial fascial tissue or fat injections, upper lip shortening, perioral dermabrasion, ear lobe reduction, buccal fat reduction, mentum lifting, and upper orbital rim shaving. Complications, postoperative follow-up, esthetic outcomes, and contribution of the ancillary procedures were recorded.Our esthetic face complication rates were comparable to those of previous studies and included chemosis, hematoma, cyst on the eyelid suture line, skin sloughing, scar abnormalities (hypertrophic scar and widespread scar), pseudoparalysis of the marginal mandibular branch, temporary hypoesthesia of the forehead, irregularity of the glabella after endoscopy, and asymmetry. We did not observe any comorbidity owing to genioplasty and augmentation with autologous tissue except for a case with infection after fat injection.More improvement can be obtained with careful planning of ancillary procedures in face-neck lifting surgery.

The Application of 3D Printing Technology for Simultaneous Orthognathic Surgery and Mandibular Contour Osteoplasty in the Treatment of Craniofacial Deformities

BACKGROUND

Because of the limitation of specific preoperative design and surgical templates, orthognathic surgery and mandibular contour osteoplasty are generally performed in two stages. Three-dimensional printing technology has improved the accuracy of the surgery and results in good surgical predictability easily. This study aims to confirm the effectiveness, feasibility and precision of simultaneous mandibular contour osteoplasty and orthognathic surgery with the assistance of 3D printing technology.

METHODS

Ten patients, who were diagnosed with mandibular hypertrophy and bimaxillary deformities, were included in the study. In addition to conventional orthognathic surgery, mandibular angle ostectomy, mandibular outer cortex grinding or mandibular border ostectomy was designed for mandibular hypertrophy. Optimal osteotomy lines and simulated surgeries were designed according the 3D printing model of the mandible. Then, surgical templates were made on the 3D printing model. No muscle excision was performed in any patient. Preoperative, predicted and postoperative measurements were taken, including the gonial angle (Ar-Go-Me) and the mandibular width (Go-Go).

RESULTS

All the patients had a reposeful postoperative recovery, with no indication of obvious infection, facial paralysis, osteonecrosis or bone displacement. The gonial angle was improved from 110.3° ± 11.1 to 121.3° ± 2.9, and the mandibular width was improved from 117.5 mm ± 6.8 to 111.9 mm ± 4.2. The discrepancies between simulation and postoperation of the left gonial angle, the right gonial angle and the mandibular width were 0.56° ± 0.22, 0.65° ± 0.3 and 0.49 mm ± 0.43, respectively.

CONCLUSIONS

The results of our study illustrated the predictability, feasibility and reliability of simultaneous mandibular contour osteoplasty and orthognathic surgery with the assistance of 3D printing technology. Our technique could achieve functional improvement and an aesthetic profile at the same time.

LEVEL OF EVIDENCE IV

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 .

Dentofacial Considerations in Genioplasty

Chin augmentation, particularly with implants, has become popular in recent years. For the most part, the focus is on the position of the pogonion. The rest of the mid-face, including the maxilla and mandible, are usually ignored. In this article, different scenarios and deformities in the maxillofacial complex that can affect the chin position and shape of its overlying soft tissue are illustrated. It is the author’s view that a number of genioplasty augmentation procedures should be deferred. Discussion of alternative treatments should take place with patients regarding their underlying skeletal issues.

[PLASTIC CLOSURE OF THE WOUND DEFECT IN PATIENTS, SUFFERING THE ORAL AND ORO-PHARYNGEAL CANCER STAGES ІІІ - ІV]

Results of treatment of 124 patients, suffering locally-advanced oral and oropharyngeal cancer were analyzed. In these patients after wide excision of tissues the defect has occurred, which would be impossible to close using simple suturing. To these patients a primary plasty, using musculo-cutaneous or adiposo-cutaneous flap, was performed. The defect, occurring after resection of the oral cavity floor together with the mandibular anterior fragment, constitutes the most complex one for the plasty performance. The main principles of the defects plasty were determined. The plastic material choice depends on peculiar clinical situation, the surgical intervention volume, the defect localization and its size.

[Aesthetic success in genioplasties procedures criteria]

Maxillomandibular dysmorphia may be associated with structural chin pathologies. Three-dimensional jaws displacements have limits. Specific genioplasty is an additional surgical mean for soft tissues profile normalization. Osteotomy line is examined according an incline angle and a possible lateral extension, as chin wing technique, improves facial shape. Cephalometric set-up with R line analyzes surgical chin movements and impact of lower incisors labial inclination on lower lip and mentolabial fold after advancement genioplasty. Micro-implant anchorage is a precious help to find lower incisors good position and optimum lower occlusal plane frontal shift in asymmetric facial pattern. Orthodontics criteria are essential factors to access an aesthetic success in genioplasties procedures.

Bimaxillary Orthognathic Approach to Correct Skeletal Facial Asymmetry of Hemifacial Microsomia in Adults

BACKGROUND

Hemifacial microsomia (HFM) is the second most common congenital craniofacial deformity after cleft lip and palate. Distraction osteogenesis (DO) is regarded as an alternative and efficient treatment option for patients with HFM. However, DO was not proven effective for all cases, and the results of long-term follow-up were not satisfactory as expected. Compared with DO, the orthognathic surgery approach may offer more stable clinical outcomes for this kind of disease. The purpose of this study is to evaluate the long-term clinical and radiographic outcome of bimaxillary orthognathic surgery in the treatment of adult HFM.

METHODS

Eight patients with HFM who had undergone bimaxillary orthognathic surgery between 2008 and 2012 were included in the study. The surgical procedures included Le Fort I osteotomy, inverted-L osteotomy, sagittal split ramus osteotomy, genioplasty, and iliac bone grafting. Pre- and postoperative orthodontic treatments were performed, respectively. Clinical and radiographic examinations were carried out to assess postoperative outcomes.

RESULTS

No obvious complications appeared postoperatively and no recurrences occurred during follow-up. All patients obtained satisfactory aesthetic results. Marked improvement in facial contour and occlusion were observed. Plain radiographs showed that the height ratios between the affected and unaffected ramus were ameliorated significantly.

CONCLUSION

The bimaxillary orthognathic approach to correct the deformity of adult HFM can obtain stable results in the long-term follow-up, and should be considered as a priority method for the treatment of adult patients with dentofacial deformity.

LEVEL OF EVIDENCE V

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[Not Available]

Albino Triaca a été chef de clinique au centre de chirurgie maxillo-faciale et d’esthétique de San Marin. Il est également depuis un an professeur du service de chirurgie maxillo-faciale de Salzbourg, où il dirige plus spécifiquement le service de la chirurgie du nez. Il exerce depuis plus de 30 ans à la Klinik Pyramide au bord du lac de Zurich où il me reçoit pour cet entretien.

Chin Microgenia: A Clinical Comparative Study

BACKGROUND

The aesthetic relevance of the chin and its relatively simple correction through different approaches make genioplasty one of the most performed aesthetic procedures of the face. Sliding genioplasty is extremely rewarding, particularly when performed as an adjunction to rhinoplasty, rhytidectomy, or jaw surgery. In the scientific literature, many different surgical techniques are described, but the biological implications and the economical impact can shape the surgeon's decision on which can be the best treatment: surgical correction with osteotomy, chin implants, or with fillers.

OBJECTIVE

The authors propose a decision making protocol for correcting chin microgenia based on a revision of 345 treated cases.

METHODS

A retrospective review of 345 cases of chin microgenia was undertaken to understand the proper preoperative assessment and therapeutic planning. A total of 135 patients were treated with surgical sliding genioplasty (group A): 60 patients (group B) have been grafted with alloplastic implants and the remaining 150 patients (group C) with hyaluronic acid. We recorded clinical indications, complications, and long-term aesthetic results at 3-year follow-up.

RESULTS

The analysis of the results based on the entity of the chin's sagittal defect, the chin soft-tissue thickness, the patient's age, and self-judgment allows for simplified treatment planning for sagittal chin deformities showing a greater predictability and a more stable long-term aesthetic result regarding sliding genioplasty compared to alloplastic implant placement and fillers.

CONCLUSIONS

Our proposal for a simple and versatile protocol of chin microgenia aims to simplify the therapeutic indications for a predictable and a stable long-term aesthetic result.

LEVEL OF EVIDENCE II

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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Combined surgical-orthodontic treatment: how did it evolve and what are the best practices now?

It has been 50 years since the landmark presentation by Hugo Obwegeser at Walter Reed Army Hospital. At that conference, Professor Obwegeser offered American surgeons techniques to correct facial skeletal deformities with access through intraoral incisions. As important advances in surgical technique and anesthesia evolved for the surgical procedures, a major contribution by American orthodontists in collaboration with surgeons was the creation of a common diagnostic, planning, and treatment scheme for use by both clinician groups in the treatment of dentofacial deformities, the skeletal and dental problems of the most severely affected 5% of the population. This article summarizes what American orthodontists and surgeons have learned in the late 20th and early 21st centuries, and forecasts what might be the future of treatment for patients with dentofacial deformities.

[Different maxillomandibular advancement methods for the treatment of severe obstructive sleep apneahypopnea syndrome]

OBJECTIVE

To review the outcomes of three different methods of maxillomandibular advancement for the treatment of severe obstructive sleep apnea-hypopnea syndrome (OSAHS).

METHODS

Twenty-four patients with severe OSAHS from January 2011 to January 2014 treated by three different methods of maxillomandibular advancement (MMA) and genioplasty, maxillomandibular advancement without rotation plus genioplasty, maxillomandibular advancement with counterclockwise rotation plus advancement genioplasty, maxillomandibular advancement with first premolars extraction and subapical osteotomy setback under general anesthesia were included in the study. Comparison of per-operative and post-operative cephalometric analysis, polysomnography (PSG), apnea and hypopea index (AHI), body mass index (BMI), average blood oxygen saturation (AOS), lowest oxygen saturation (LSaO2) and posterior airway space (PAS) data were performed. The operative time and post-surgical orthodontic treatment data were collected and analyzed.

RESULTS

According to Stanford criteria, the success rate of 100% was achieved with all the three methods. The difference between per-operative and post-operative AHI, AOS, SNPg and PAS were statistically significant (P<0.0001) for all the three methods. Significant difference was found between per-operative and post-operative SNA (81.51°±3.36° vs 88.17°±4.51°, P<0.0001), (82.25°±2.71° vs 86.54°±3.65°, P=0.0002) and SNB (72.37°±3.99° vs 80.59°±3.40°, P<0.0001), (73.65°±3.80° vs 81.37°±2.96°, P<0.0001) among MMA without rotation plus genioplasty and MMA with counterclockwise rotation and advancement genioplasty respectively. However, no significant difference was found between the pre-operative and post-operative SNA (82.18°±4.27° vs 84.19°±2.70°, P=0.2015) and SNB (73.28°±3.04° vs 75.35°±2.56°, P=0.2640) among MMA with first premolars extraction and subapical osteotomy setback. The average duration of postoperative orthodontics treatment was 8.3 months.

CONCLUSIONS

MMA and advancement genioplasty is an effective surgical management for severe OSAHS. Cephalometric analysis and computer aided design are needed for personalized surgical methods. MMA without rotation and advancement genioplasty method leads to the protrusive skeletal deformity. MMA with counterclockwise rotation and advancement genioplasty method is effective in curing severe OSAHS with little effect on facial profile. MMA with first premolars extraction and subapical osteotomy requires longer operative time and longer postoperative orthodontic treatment.

Distraction osteogenesis and orthognathic surgery for a patient with unilateral cleft lip and palate

Maxillary deficiency is a common feature in patients with repaired cleft lip and palate. Orthognathic surgery has been the conventional approach for the management of cleft-related maxillary hypoplasia. However, for patients with a severe maxillary deficiency, orthognathic surgery alone has many disadvantages, such as high relapse rates of 25% to 40%, instability, limited amount of advancement, and a highly invasive surgical technique. As an alternative treatment method, distraction osteogenesis has been used successfully in the distraction of the mandible, the maxilla, the entire midface, and the orbits as well as the cranial bones, with stable outcomes. The type of distraction device, either external or internal, can be chosen based on the surgical goals set for the patient. In this study, we report on the use of a rigid external distraction device for maxillary advancement in a 22-year-old woman with a repaired unilateral cleft lip and palate and severe maxillary hypoplasia. After the distraction osteogenesis, 2-jaw surgery was performed to correct the maxillary yaw deviation and the mandibular prognathism.

Impact of Perioperative Fluid Administration on Postoperative Morbidity and Length of Hospital Stay Following Maxillomandibular Advancement for Obstructive Sleep Apnea

PURPOSE

The purpose of this study was to evaluate whether the volume of perioperative fluids administered to patients undergoing maxillomandibular advancement (MMA) for treatment of obstructive sleep apnea (OSA) is associated with an increased incidence of postoperative complications and prolonged length of hospital stay.

MATERIALS AND METHODS

A retrospective cohort study design was implemented and patients undergoing MMA for OSA at the Mayo Clinic were identified from 2001 through 2014. The primary predictor variable was the total volume of intravenous fluids administered during MMA. The primary outcome variable was length of hospital stay in hours. Secondary outcome variables included the presence of complications incurred during postoperative hospitalization. Additional covariates abstracted included basic demographic data, preoperative body mass index, preoperative apnea-hypopnea index, preoperative Charlson comorbidity index, preoperative American Society of Anesthesiologists score, type of intravenous fluid administered, surgical complexity score, duration of anesthesia, duration of surgery, and the use of planned intensive care unit admission. Univariate and multivariable models were developed to assess associations between the primary predictor variable and covariates relative to the primary and secondary outcome variables.

RESULTS

Eighty-eight patients undergoing MMA for OSA were identified. Total fluid volume was significantly associated with increased length of stay (odds ratio [OR] = 1.34, 95% confidence interval [CI], 1.05-1.71; P = .020) in univariate analysis. Total fluid volume did not remain significantly associated with increased length of hospital stay in stepwise multivariable modeling. Total fluid volume was significantly associated with the presence of postoperative complications (OR = 1.69; 95% CI, 1.08-2.63; P = .021) in univariate logistic regression.

CONCLUSION

Fluid administration was not found to be significantly associated with increased length of hospital stay after MMA for OSA. Increased fluid administration might be associated with the presence of postoperative complications after MMA; however, future large multicenter studies will be required to more comprehensively assess this association.

[Skeletal discrepancies: could we avoid surgical procedures?]

Orthodontic-surgical protocols are nowadays considered as the state-of-the-art in cases of skeletal dentomaxillary dysmorphosis. However, for some reasons, it may happen that unquestionable indications for orthodontic-surgical procedures are not respected, patients being treated by orthodontics alone. This kind of mistake in the treatment planning lay the patient open to various potential complications such as: abnormal duration of the orthodontic treatment, dental root resorptions, questionable tooth extraction, unfavorable facial aesthetics, treatment instability... The authors discuss these points illustrated by clinical cases. Although orthognathic surgery protocols became considerably simplified these last two decades, orthodontic-surgical protocols are still relevantly considered as heavy both by patients and practitioners. As a consequence, their indication must be carefully weighed by a multidisciplinary team, keeping in mind that these protocols represent the ultimate functional and aesthetic treatment for dento-skeletal dysmorphoses.

[Seniors and orthodontics: from denial to a reasonable choice]

When patients older than 60 decide to undergo orthodontic treatment, their motivation is not merely for esthetic purposes; it is also intended to preserve their biological capital. Their treatment is often complicated. The orthodontist has to take into account any particularities related to their past dental or even orthodontic history. Their treatment are freed, sometimes due to necessary compromises, from constraints that are determined by the occlusion, the periodontium or by prosthetic devices which are sometimes implant borne. For some patients, the original shape of their teeth that make up their smile are an integral part of their personality. By preserving the integrity of these teeth with an orthodontic treatment they avoid the sudden and jarring transformation of their smile and maintain their identity. Therapeutic choices that combine orthodontics and prosthetics and sometimes surgery can preserve the senescence of a face.

Does the Kushida morphometric model predict outcomes following maxillomandibular advancement surgery for obstructive sleep apnoea?

OBJECTIVE

The primary aim of this study was to explore the predictive potential of the preoperative Kushida index score and subsequent outcome following maxillomandibular advancement surgery (MMA). Secondarily we looked at how well the Kushida values of our OSA patients matched the morphometric models diagnostic thresholds.

METHODS

We performed a retrospective analysis of patients who underwent MMA for OSA at our institution. Kushida morphometric scores were calculated using the described formula: P + (Mx - Mn) + 3 × OJ + 3 × [Max (BMI - 25)] × (NC ÷ BMI). Regression analysis was performed to explore the possible association between Kushida index score and outcome variables of postoperative apnoea/hypopnea indices (AHI) and Epworth Sleepiness Scores (ESS).

RESULTS

We identified 28 patients with complete data available for analysis. The mean age was 45 years (SD 6) with mean BMI of 28 (SD 3). All, but one patient underwent bi-maxillary procedure with or without genioplasty, with a mean advancement of 8.5 mm (SD 2). The mean Kushida index score in our sample was 79 (SD 14). 89% of patients had postoperative AHI <15 in keeping with surgical success. We found no statistically significant relationship with Kushida morphometric model variables and overall score with either of our outcome variables.

CONCLUSION

The mean Kushida index score in our patients was in the range consistent with the morphometric models diagnostic cut-off for OSA. Kushida's morphometric model does not appear to be a good predictor of postoperative success in individuals following MMA. The morphometric model represents a clinical adjunct in the initial diagnostic work-up of OSA patients referred for surgery.

Long-term orthodontic and surgical treatment and stability of a patient with Beckwith-Wiedemann syndrome

Beckwith-Wiedemann syndrome (BWS) is a congenital growth disorder. Children born with BWS develop enlarged organs, including the tongue, a large body, and other signs. A woman with BWS was treated and followed for 30 years. Treatment consisted of tongue reduction, orthopedic and orthodontic treatment, orthognathic surgery, and retention. The patient was first treated when she was 5 years old. Her original orthodontic problems included macroglossia, anterior open bite, anterior crossbite, and a skeletal Class III jaw relationship caused by significant mandibular protrusion. The jaw-base relationships did not improve in the early preadolescent period after phase 1 of orthodontic treatment with a vertical chincap. With the growth spurt accompanying puberty, she developed a severe skeletal Class III jaw relationship and a constricted maxillary arch. Surgically assisted rapid maxillary expansion was performed at 23 years of age to correct the severe discrepancy between the maxillary and mandibular dental arch widths. Then, at 26 years, a LeFort I osteotomy, a horseshoe osteotomy, a bilateral sagittal split ramus osteotomy, and genioplasty were performed after presurgical orthodontic treatment with extraction of the mandibular first molars. Both the facial profile and the occlusion were stable after 6 years of retention. This case report discusses the result of long-term observation of a patient with BWS who underwent tongue reduction, early orthodontic treatment, and surgical-orthodontic treatment.

[Orthognathic surgery in adults: state of the art]

The objective of orthognathic surgery is the repositioning of the osseous bases of the jaws. Its consequences are both aesthetic and functional. As adults are increasingly concerned with appearance, orthognathic surgery is today, more than ever, a close collaboration between the orthodontist, surgeon and general dentist. The whole team must be capable of coordinating its approach with an aesthetic objective. For the surgeon, a perfect knowledge of complementary techniques (rhinoplasty, bone grafts, plastic surgery of the face, lipostructure or fillers) makes orthognathic surgery a completely separate surgical speciality. The aim of this article is to establish the philosophy underlying this type of treatment and define relevant fundamental aspects. We propose an esthetic "extra-oral" clinical approach not focused on occlusal anomalies but on classification of tooth positional abnormalities in the smile and the therapeutic options that we have for placing teeth in correct positions in the smile.

Lingual orthodontics as an aesthetic resource in the preparation of orthodontic/surgical treatment

The lingual technique was introduced in the late '70s and, just like orthodontics, it has developed significantly in the past few years. Adult and young adult have been attracted to such alternative aesthetic treatment. Despite their need of orthodontic treatment, they want to have an aesthetic alternative, as "invisible" as possible--something that can be achieved with the lingual technique. Nevertheless, many treatment or re-treatment cases also demand correction through orthognathic surgery, a process which is nowadays much simpler and considered an effective auxiliary method for the malocclusion correction. Having posed that, this study aims to show correction of malocclusion and discrepancy between dental arches through lingual orthodontic technique associated to orthognathic surgery. This study shows that it is possible to provide the patient who suffers frJom malocclusion with proper correction, achieving the desired aesthetics by using lingual braces and pe?forming lingual orthognathic surgery.

Narrowing and lengthening genioplasty with pedicled bone graft in contouring of the short and wide lower face

BACKGROUND

A short and wide lower face is perceived as unattractive and masculine. Simply contouring the mandibular body and angle is insufficient to make the lower face with short and wide features slimmer and more feminine. In many cases, vertical elongation of the chin together with a bone graft is necessary. This can cause infection, donor-site morbidity and height loss by resorption of the grafted bone. To prevent this problem, the authors performed a pedicled interpositional graft with the discarded bone from narrowing genioplasty, and the results were aesthetically satisfactory.

METHODS

From March 2010 to September 2011, 32 patients who received chin narrowing and vertical lengthening surgery at the authors' clinic were included in this study. For all the patients, the remnant mandibular bone at the stepoff from the site of the genioplasty to the mandibular angle was reduced concurrently.

RESULTS

No complications occurred, and all the patients were satisfied with their postoperative results.

CONCLUSION

Harmonizing the vertical length and transverse width of the chin is essential to acquiring more favorable results in mandibular contouring. The authors recommend pedicled interpositional bone grafting in narrowing genioplasty as a safe and useful method for aesthetic chin lengthening.

LEVEL OF EVIDENCE IV

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 .

[Aesthetic profiloplasty: retrospective study of 101 cases]

OBJECTIVES

Aesthetic profiloplasty focuses on patients with normal dental occlusion and summarizes the association of a rhinoplasty and genioplasty. The aim of our study is to analyze the dysmorphoses overall profile, as well as different surgical techniques. This also allows to validate a method of analysis and construction of an aesthetic project based on a profile photograph.

MATERIALS AND METHODS

This is a retrospective study of 101 adult patients undergoing profiloplasty at our institution over a period of 35 years.

RESULTS

18 patients (17.8%) had an abnormality of the nasofrontal angle, 62 (61.3%) abnormal and the nasolabial angle 101 a chin dysmorphia.

CONCLUSION

We studied profiloplasty focusing on its borders, first of all the nasal profile and then the facial profile with the chin. Our profilometric building is simple, didactic and to obtain a good cosmetic result. The Marseilles School Pech and Cannoni was intended, regarding rhinoplasty, trying to get a natural result for a consistent look. Through profiloplasty we continued this teaching of "natural reworked" to achieve the most harmonious profile.

Skeletal stability after mandibular advancement in bilateral sagittal split osteotomies during adolescence

Bilateral sagittal split osteotomy (BSSO) is the most frequently performed surgery for correcting mandibular retrognathia. Few studies have reported the use of BSSO in young patients, as growth may cause relapse. The aim of the present study was to determine the amount of relapse after performing BSSO in patients aged less than 18 years. Patients who had a mandibular advancement by BSSO surgery between January 2003 and June 2008 were evaluated. Eighteen patients were treated before the age of 18 years and compared with patients treated at 20-24 years of age. Cephalometric radiographs were used to determine the amount of relapse. For patients aged less than 18 years, the mean horizontal relapse after 1 year was 0.5 mm, (10.9% of perioperative advancement). For patients aged 20-24 years, the mean relapse was 0.9 mm, (16.4% of perioperative advancement). There were no significant differences between the age groups (p > 0.05). In conclusion, the BSSO procedure is a relatively stable procedure, even during adolescence.

Soft tissue genioplasty. New modality of chin surgery utilizing mentalis muscle only

OBJECTIVE

To introduce a unique newly modified non-invasive surgical technique of genioplasty, where the mentalis muscle is advanced surgically for some selected indicated patients.

METHODS

This technique was carried out at the Department of Oral and Maxillofacial Surgery, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. From January 2009 to December 2011, 20 medically fit patients with acceptable facial profile, and age range from 18-25 years were selected as candidates for chin advancement, approximately 3-5 mm based on their lateral cephalometric tracings followed by mentalis muscle tightening.

RESULTS

In all patients, soft tissue analysis of the lower lip and chin in lateral cephalogram were increased in horizontal and vertical dimensions demonstrating a good post-operative improvement and patient satisfaction within one-year follow up.

CONCLUSION

Soft tissue genioplasty provides superior versatility in surgical alteration of the chin morphology, mostly in horizontal dimension, utilizing mentalis muscle only without any hardwares. It is a time saving procedure obtained under local anesthesia. It preserves mentalis muscle attachment without dissection of the mentalis nerve.

Improvement of chin profile after mandibular setback and reduction genioplasty for correction of prognathism and long chin

BACKGROUND

This study evaluated the changes in the chin profile after using mandibular setback and vertical chin reduction genioplasty to correct mandibular prognathism associated with a long and flat chin.

METHODS

Sixteen consecutive patients (6 male and 10 female) underwent surgery at a mean age of 22.6 years (range = 18.2-27.8 years). The evaluation consisted of hard and soft tissue analysis before and after treatment.

RESULTS

The results showed that improvement in facial profile, chin contour, and dental occlusion was achieved. After an average of 9.4-mm mandibular setback and 5.1-mm vertical osseous chin reduction, the thickness of soft tissue pogonion was increased by 4.0 mm, the supramentale thickness was increased by 1.8 mm, and lower-lip thickness was increased by 1.6 mm. Thus, the mentolabial fold increased from 3.4 to 4.7 mm and the mentolabial angle decreased from 153.4 to 136.9°. The vertical lip:chin ratio became normal.

CONCLUSION

The results of this study demonstrated that mandibular setback combined with vertical chin reduction genioplasty offers an alternative for the treatment of patients suffering from mandibular prognathism with a long, nonprojecting chin.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article.