Evaluation and treatment of deformities of the chin

Chin deformities present commonly to the facial plastic surgeon. Proper evaluation of the face is essential to allow the surgeon to counsel the patient properly regarding optimal management of chin deformities. This article reviews such analysis and discusses treatment modalities, including both the use of chin implants and osseous genioplasty.     

Osseous genioplasty in facial aesthetic surgery--a personal perspective reviewing 54 patients.

The chin is an important and often neglected feature of facial balance. Genioplasty is a useful procedure in aesthetic surgery and often can be combined with other procedures to obtain an optimal aesthetic outcome. A retrospective case note review of the senior author's (BMJ) experience of aesthetic genioplasty over an 11-year period was undertaken. Cases with non-aesthetic indications for genioplasty were excluded and overall 64 patients were included in this study. Our technique of intraoral osseous genioplasty is described and discussed. A total of 54 patients underwent osseous genioplasty, eight underwent alloplastic genioplasty and two underwent removal of a chin prosthesis only. Most of the patients who had an osseous genioplasty had a sliding advancement correction. Four of these patients required secondary surgery, five had additional minor complications and there were seven cases of transient numbness. Nine patients had a genioplasty alone, 26 had one additional procedure and 19 had more than one, with an average of 2.9 additional procedures. Twenty-four patients had a simultaneous rhinoplasty and 18 had a facelift. Osseous genioplasty is our preferred technique for its versatility and long-term stability compared to alloplastic methods. If performed correctly it provides excellent results with a high degree of patient satisfaction and few long-term complications.     

颏成形术发展及现况

颏部是维持面部平衡和协调的重要元素,大小和空间位置的变化可导致各种畸形。颏成形术是最早开展的颅颌面轮廓整形之一,主要包括假体植入隆颏术、自体骨植入隆颏术和颏截骨成形术。近年来,计算机辅助外科、机器人外科及3D打印技术开始应用于颏成形术中。本文对颏成形术的发展及现况进行综述。     

The surgical tools: the LeFort I, bilateral sagittal split osteotomy of the mandible, and the osseous genioplasty

Orthognathic surgery involves the surgical manipulation of the elements of the facial skeleton to restore normal anatomic and functional relationships in patients who have dentofacial skeletal anomalies. The elements of the facial skeleton can be repositioned, redefining the face through a variety of well-established osteotomies. Most maxillofacial deformities can be managed with the three basic osteotomies discussed in this article: the LeFort I type osteotomy, the bilateral sagittal split osteotomy of the mandibular ramus, and the horizontal osteotomy of the symphysis of the chin (osseous genioplasty).     

Osseous genioplasty: A case series

Introduction:

The chin (mentum) is vital to the human facial morphology as it contributes to the facial aesthetics and harmony both on frontal and lateral views. Osseous genioplasty, the alteration of the chin through skeletal modification, can lead to significant enhancement of the overall facial profile.

Aim and Study Design:

A case series was designed to study the long-term results of osseous genioplasty in Indian patients with regard to patient satisfaction, complications, and long-term stability.

Materials and Methods:

All subjects who underwent osseous genioplasty either alone or as a component of orthognathic surgery between January 1992 and December 2010, with a minimum follow-up of 2 years, were included. The genioplasty was performed using standard protocols of assessment and execution. Post-operative evaluation included patient satisfaction, complications and radiological evidence of long-term stability. A comprehensive score was formulated for the purpose of the study.

Results:

Thirty-seven subjects underwent osseous genioplasty with at least 2 years of follow-up in the study period. This included 17 male and 20 female subjects, with a mean age of 22.8 years (15-52 years) and a mean follow-up of 3 years 4 months (2 years to 4 years and 11 months). Nineteen subjects underwent isolated genioplasty while 18 underwent genioplasty as a part of orthognathic surgery. The procedures included advancement (22), pushback (9), side-to-side (4) and vertical reduction (2) genioplasty. Thirty-six subjects (97.3%) were extremely pleased with the results with only one subject expressing reservations, without, however, demanding any further procedure. There were no significant complications. The osteotomised segment was well maintained in its new position with good bony union and minimal resorption. Overall, 35 (94.6%) cases had excellent results and 2 (4.4%) cases had good results, according to the comprehensive score.

Conclusions:

Osseous genioplasty is a safe and effective means of creating a beautiful and balanced facial profile by producing alterations in the chin morphology with minimal complications and excellent and stable long-term results.KEY WORDS: Chin deformity, mentoplasty, osseous genioplasty     

A New Face by Combined Surgery for Patients with Complex Dentofacial Deformity

BACKGROUND: This article aims to present and discuss 53 patients who received a new identity because of major changes to the face after treatment with bimaxillary osteotomy, concomitant maxillomalar augmentation, genioplasty, and rhinoplastic procedures for their complex dentofacial skeletal deformity and class 3 malocclusion. METHODS: During a 12-year period (January 1993 to April 2005), more than 500 patients with dentofacial deformities and malocclusions have undergone orthognathic surgery performed by a team consisting of the same plastic surgeons and orthodontists. Among this group, 53 patients (30 women and 23 men) underwent surgery for both aesthetic and functional concerns. The mean patient age was 20.4 years (range, 17-28 years). All the patients were treated with bimaxillary osteotomy, concomitant maxillomalar augmentation, osseous genioplasty, and rhinoplastic procedures in the same session. The patients were followed 12 to 44 months by the plastic surgeon, and at least 1 year by the orthodontist. RESULTS: There was no orthognathic relapse or other major complications requiring reoperation. There was prolonged nerve anesthesia or hypoesthesia that resolved within 6 months for 4 patients (7.5%), a short period of anesthesia or hypoesthesia that resolved within 4 weeks for 11 patients (20.7%), a wide alar base in 3 patients, and a slight deviation of the cartilage septum in 2 patients. CONCLUSION: In one session, five different procedures can be performed without any problem, each of which can produce major changes to the face while maintaining the whole facial harmony. The authors determined that these dramatic positive outcomes for the combined procedure can easily be tolerated and accepted by all their patients. However, the patients have had difficulty with their family or friends accepting their new appearance, and even have had to change their photos on identification cards. This is encouraging for the management of new patients in the future.     

Management and avoidance of complications in chin augmentation

Chin augmentation is an extremely rewarding cosmetic operation, particularly when performed as an adjunct to rhinoplasty and rhytidectomy. There has been much debate regarding the ideal surgical approach and whether implant placement or osseous genioplasty is the superior operation. Regardless of the technique, all surgery carries an inherent risk for complications, and it is the surgeon's responsibility to learn which techniques will work best in his or her hands for each patient. Certain complications can be almost unavoidable, but a solid foundation in anatomy and a review of the existing literature can help minimize the risk of certain problems while providing an improved understanding of how to recognize and manage them when they occur. The authors present a comprehensive review of genioplasty and chin implant complications, how they might be avoided, and management methods if they occur.     

Long-term results of vertical height augmentation genioplasty using autogenous iliac bone graft.

OBJECTIVE: In order to clarify the clinical utility of the vertical height augmentation (VHA) genioplasty using autogenous iliac bone graft (IBG), this study examined the postsurgical changes in hard and soft tissues of the chin and the stability of the grafted bone. STUDY DESIGN: Twenty-three patients who had undergone VHA genioplasty using autogenous IBG were evaluated radiographically and clinically. A comparison study of the changes in hard to soft tissues after surgery in all 23 patients was performed with preoperative, 1-month, 3-months, 6-months, and/or 1-year postoperative lateral cephalograms by tracing. Stability, bone healing, and complication of the grafted bone was evaluated by follow-up radiographs and clinical observation. RESULTS: Between the preoperative and 6-month postoperative tracings, an average vertical augmentation of the osseous segment was 4.2 mm at menton and that of the soft tissue menton was 4.0 mm. There was a high predictability of 1:0.94 between the amounts of hard versus soft tissue changes with surgery in the vertical plane. The position of the genial bone segment was stable immediately after surgery and soft tissue was not changed significantly from 1 month to 1 year after operation. Clinical and radiological follow-up results of the iliac bone graft showed normal bony union and were generally stable. CONCLUSIONS: VHA genioplasty using IBG is a reliable method for predicting hard and soft tissue changes and for maintaining postoperative soft tissue of the chin after surgery.     

Orthognathic surgery and a tale of how three procedures came to be: a letter to the next generations of surgeons

Although the transoral sagittal splitting of the ramus, the osseous genioplasty, and the LeFort osteotomy today are common procedures used by many specialties to solve a broad range of problems, this was not always so. This article describes Hugo Obwegeser's firsthand experience of how these procedures came to be.     

Genioplasty and Chin Augmentation with Medpore Implants: A Report of 650 Cases

Background Genioplasty is an old and useful technique. Chin augmentation with Medpore has become popular in recent years. The authors briefly examine their experience with the two techniques. Methods From 2000 to date, 500 genioplasties and 150 chin augmentations with Medpore have been performed. The versatility and benefits of the two techniques are discussed. Results Most of the patients achieved satisfactory results with few complications. Genioplasty is recommended for severe developmental or complicated retrogenia and for deviated chin. Both techniques can be used for mild to modest retrogenia. Medpore is especially useful for patients who need a meticulous revision of the chin shape or contour. Conclusions Chin shape and contour are as important as the chin position. Although genioplasty has the widest range of indications, chin augmentation with Medpore has the advantage of minimal risk for some patients who need to change the chin shape or contour. Medpore is totally different from other alloplastic chin implants such as silicone.     

颏成形术在下颌角肥大整形术的同期应用

目的 探讨下颌角肥大(又称方下颌畸形)整形术联合颏成形术的治疗效果.方法 根据面型特征及定位头颅测量分析,制定面下1/3整体轮廓塑形方案.采用口内入路双侧下颌角截骨治疗下颌角肥大后,同期行颏部整形术,治疗伴有的颏部畸形.结果 2000～2006年采用以上术式收治18例,术后面部整体轮廓改善明显,下颌及外形符合美学标准,颏唇沟形态自然.结论 下颌角肥大伴颏部畸形在双侧下颌角截骨整形的同时,行颏部整形术,有利于面部整体轮廓的改进与提高.     

高密度多孔聚乙烯假体置入隆颏在面下1／3轮廓成形术中的应用

目的探讨高密度多孔聚乙烯（porous high-density polyethylene,Medpor）假体置入隆颏在面下1／3轮廓成形术中的应用效果。方法149例同时行口内入路Medpor假体置入隆颏及面下1／3轮廓整形,其中行双侧下颌角截骨成形术121例,行双侧下颌角截骨成形术及双侧颧骨截骨降低术28例,并进行术前术后照相对比,观察判断临床效果。结果术后145例（97．3％）颏部外形及面下1／3轮廓改善满意。2例（1．3％）感觉颏部突度改善欠佳,其中1例再次行Medpor假体取出及颏部截骨前移颏成形术。1例（0．7％）感觉颏部假体偏大,行二次手术将假体修小;1例（0．7％）术后6个月因假体偏斜改行颏部截骨颏成形术。20例（13．4％）术后短期感觉下唇麻木,1～3个月后基本消失。随访期间没有发现伤口血肿、感染及假体外露、断裂等并发症。结论Medpor假体组织相容性好,同时经口内入路置入隆颏及下颌角截骨成形术在面下1／3轮廓整形中效果良好。     

颏部缩窄截骨结合Medpor隆颏矫正颏部宽大后缩畸形

目的：探讨一次性矫正颏部宽大及颏部后缩畸形的方法。方法：应用颏部缩窄截骨结合高密度多孔聚乙烯（Medpor）隆颏矫正颏部宽大后缩畸形患者11例。结果：11例患者颏部宽大及后缩畸形得到矫正,效果满意。结论：颏部截骨缩窄结合Medpor隆颏可一次性矫正颏部宽大及颏部后缩畸形,解决了单纯颏部截骨术后或单纯隆颏术后局部不能达到最佳的手术效果的弊端。     

The sagittal curving osteotomy: a modified technique for advancement genioplasty.

PURPOSE: The purpose of the present study was to develop a new type of osteotomy for advancement genioplasty to decrease the incidence of neurosensory disturbance of the chin. PATIENTS AND METHOD: Forty-six patients who suffered from a slight or moderate degree of microgenia received a sagittal curving osteotomy for advancement genioplasty. Patients were followed for 1-6 months to assess the neurosensory function of the chin region by evaluating light-touch perception. The control group, 57 patients, who suffered from the same degree of microgenia, received a horizontal sliding osteotomy. They were operated on by the same surgical group and were followed for 1-33 months. RESULTS: All of the test and control patients were satisfied with the aesthetic results of the surgery. In the test group, 47 sides (51.87%) of 92 total left and right sides of chins had a transient neurosensory deficiency but none had permanent neurosensory deficiency. In the control group, 98 sides (86.84%) of 114 total chin sides had a transient neurosensory deficiency and five sides (4.43%) of 114 total chin sides had permanent neurosensory deficiency. When applied to patients who suffer from a mild or moderate degree of microgenia and have normal bite function, the sagittal curving osteotomy is a simple, safe and effective technique for advancement genioplasty. This technique can distinctively decrease the incidence of neurosensory disturbance of the chin.     

Genioplasty

In 1988, I performed 15 chin procedures, seven osteotomies, and eight implants. During that same period, 38 rhinoplasties were done, but only five patients (15 per cent) had a simultaneous genioplasty. While the chin is important in nasal surgery, correction is also indicated for other aesthetic problems. Genioplasty, whether by osteotomy or implant, continues to present a unique opportunity to improve facial aesthetics with minimal risk. The current challenge is to define patient selection better, refine the technique (for example, bone substitutes and fixation hardware), and, most important, establish genioplasty firmly in the practice of plastic surgeons who perform aesthetic procedures on the face.     

The contribution of genioplasty in esthetic surgery of the face

The chin position in overall facial aesthetics is well known and it has an important influence on personality and relations with others. For most plastic surgeons, genioplasty is limited to chin advancement with alloplastic implants. Sliding horizontal osteotomy of the mandibular symphysis is not well known: the technique is simple, fast and safe. Indications are multiple (augmentation, reduction, straightening, lengthening). Improvement is both aesthetic and functional (labial gap). In deficiencies of the submental region, genioplasty may be compared to muscular transposition. Several cases of aesthetic and orthognathic surgery are presented to emphasize the value of the procedure.     

Sliding Osteotomy Genioplasty for Facial Aesthetic Balance: 10 Years of Experience

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.     

下颌角截骨移植隆颏术

目的探讨利用自体下颌角截骨块同期移植隆颏的手术方法。方法经口腔入路,利用下颌角肥大截骨术的下颌角骨块,塑形为适合颏部的形状,Ⅰ期移植于颏部,且以钛钉坚强内固定。结果本组35例患者行双侧下颌角截骨+下颌骨外板磨削术+自体下颌角移植隆颏术,术后移植骨愈合良好,颏部形态符合美学标准。结论下颌角截骨Ⅰ期移植隆颏术,操作方法简单,预期效果可靠,移植骨块与颏部解剖结合,无排异反应。     

The chin: a dynamic complex

The chin can be described as a coherent dynamic whole. The anatomical survey shows its different structures: skin, adipose tissue, platysma muscles, and osseous plane. We are underlining here the essential role for the mobility of the area of a little described anatomical element: the adipose body of the chin. We shall show the anatomical details and the dynamic interest of this structure. The chin obviously remains interconnected with the other dynamic complexes of the face. Thus the anomalies of this area will be analyzed within a coherent dynamic model interdependent from the whole face.