Abstract
The chin, one of the most obvious facial structures, plays an important role in the perception of the face as an instrument of communication. To alter the chin contour in a reliable manner, horizontal sliding osteotomy of the mandibular symphysis with advancement of the mobilized segment is the technique of choice for correction of the anterior posterior deficiency. This study describes surgical techniques used in aesthetic and functional surgery of the chin as well as the outcomes. Over a 10-year period, 474 patients underwent orthognathic surgery for correction of their malocclusion. Of these 474 patients, 155 were treated in combination with a sliding genioplasty (SGP) and 37 (29 women and 8 men; average age, 32 years; range, 18–47 years) had an isolated SGP. Of these patients, 33 had chin advancement and 4 had chin reduction. The mean chin advancement was a modest 4.5 mm (range, 2–7 mm), and the mean chin vertical displacement was 3.9 mm (range, 2.5–4.1 mm). All the patients in the mandibular deficiency group had a residual sagittal disproportion of the progonion relative to the subnasale (mean, –7.6 mm) and a newly created vertical disproportion, with mean lower face heights of 67.8 mm compared with mean midface heights of 65.3 mm. The surgical outcome was evaluated by analysis of pre- and postoperative photographs, analysis of pre- and postoperative measurements, and patients’ self judgment. All the patients healed uneventfully without any major postoperative problems. Paraesthesia of the mental nerves occurs to some degree in almost all patients measured by the Simmon Weinstein diagnostic device. In the single sliding chin osteotomy group, no major branches of the mental nerves were transacted. Paraesthesia was only transient, usually lasting for only a few weeks. At least 1 year after the operation, normal sensitivity of the lower lip and both sides of the chin was reported by almost all of the patients (93.1%). All who had only a single genioplasty recovered totally from a neurosensory deficit. The level of satisfaction was significantly high for all the patients. The results were judged to be excellent in 73.2% and good in 23.6% of the cases. Only in 3.2% of the cases was it considered to be poor (bimaxillary surgery combined with SGP). The current findings strongly suggest that SGP is a reliable procedure for achieving harmony of the lower face. In addition, it permits a simplification of facial reconstruction and rejuvenation. The combination of chin advancement and submental recontouring can have a positive effect on facial appearance, provided the increased chin projection is appropriate.
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References
Bell WH, Dann JJ: Correction of dentofacial deformities by surgery in the anterior part of the jaws. Am J Orthod 64:162–1187, 1973
Brusati R, Gianni AB: Anterior mandibular apical base augmentation in the surgical orthodontic treatment of mandibular retrusion. Int J Oral Maxillofac Surg 34:846–850, 2005
Burstone CJ: Lip posture and its significance in treatment planning. Am J Orthod 53:262–284, 1967
Burstone J: Integumental contour and extension patterns. Am J Orthod 29:93–104, 1959
Converse JM, Horowitz SL, Wood-Smith D: Deformities of the jaws. In: Converse JM (ed) Reconstructive plastic surgery. 2nd ed. WB Saunders: Philadelphia, pp. 1386–1456, 1977
Converse JM, Wood-Smith D: Horizontal osteotomy of the mandible. Plast Reconstr Surg 34:464–471, 1964
Driemel O, Kloss F, Roth B, Wurzler KK, Pistner H: Genioplasty alone and in combination: Long-term results with emphasis on sensitivity and photoanalysis. Mund Kiefer Gesichtschir 8:289–295, 2004
Fitzpatrick BN: Genioplasty with reference to resorption and the hinge sliding osteotomy. Int J Oral Surg 3:247–251, 1974
Hoenig JF: Ästhetische Chirurgie. Steinkopff Verlag: Darmstadt, pp. 134–137, 2000
Hoenig JF: Maxillomandibuläre Umstellungsosteotomien. Steinkopff Verlag: Darmstadt, pp. 59–64, 2002
Hofer O: Operation der Prognathie und Microgenie. Dtsch Zahn Kieferheilk 9:121–133, 1942
Hohl TH, Epker BN: Macrogenia: A study of treatment results, with surgical recommendations. Oral Surg Oral Med Oral Pathol 41:545–567, 1976
Luhr HG: Significance of the chin for the aesthetics of the face. Fortschr Kiefer Gesichtschir 34:23–27, 1989
McDonnell J, McNeil W, West R: Advancement genioplasty: A retrospective cephalometric analysis of osseous and soft tissue changes. J Oral Surg 35:640–647, 1977
Neuner O: Correction of mandibular deformities. Oral Surg Oral Med Oral Pathol 36:779–789, 1973
Obwegeser H, Trauner R, Obwegeser H: The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty: I. Surgical procedures to correct mandibular prognathism and reshaping of the chin. Oral Surg Oral Med Oral Pathol 10:677–689, 1957
Rabey GP: Current principles of morphanalysis and their implications in oral surgical practice. Br J Oral Surg 15:97–109, 1977
Rosen HM: Aesthetic guidelines in genioplasty: The role of facial disproportion. Plast Reconstr Surg 95:463–469, discussion 470–472, 1995
Schendel SA: Genioplasty: A physiological approach. Ann Plast Surg 14:506–514, 1985
Shaughnessy S, Mobarak KA, Hogevold HE, Espeland L: Long-term skeletal and soft tissue responses after advancement genioplasty. Am J Orthod Dentofacial Orthop 130:8–17, 2006
Spear SL, Mausner ME, Kawamoto HK Jr: Sliding genioplasty as a local anesthetic outpatient procedure: A prospective two-center trial. Plast Reconstr Surg 80:55–67, 1987
Stanton DC: Genioplasty. Facial Plast Surg 19:75–86, 2003
Trauner R, Obwegeser H: The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty: II. Operating methods for microgenia and distoclusion. Oral Surg Oral Med Oral Pathol 10:899–909, 1957
Wolfe SA, Rivas-Torres MT, Marshall D. The genioplasty and beyond: An end-game strategy for the multiply operated chin. Plast Reconstr Surg 117:1435–1446, 2006
Gonzalez-Ulloa, Stevens: The role of chin correction in Plastic and Reconstr Surg 41:477–486, 1968
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Hoenig, J. Sliding Osteotomy Genioplasty for Facial Aesthetic Balance: 10 Years of Experience. Aesth Plast Surg 31, 384–391 (2007). https://doi.org/10.1007/s00266-006-0177-6
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DOI: https://doi.org/10.1007/s00266-006-0177-6