GENIOPLASTY

Presenter : Dr. Zuber V.

3
rd
yr. MDS
Dept. of Oral & Maxillofacial Surgery
1. Introduction
2. Historical aspects
3. Various types of techniques
4. Soft tissue changes after Genioplasty
5. Complications
6. References



The chin is one of the most noticeable facial structures.
Over the last 30 years, genial area osteotomy has been
performed widely in all 3 dimensions.
Analysis of the chin deformity should involve careful
evaluation of the skeletal, dental, and soft tissue structures.
Harmony is more important than absolute proportionality.
Lip position, shape, depth of the labiomental fold, and the soft
tissue envelope covering the mandibular symphysis are the
most important aspects of the genial surgical procedure
J Oral Maxillofac Surg68:1432-1437, 2010
Transverse Reduction Genioplasty to Reduce Width of the Chin: I ndications,
Technique, and Results Sina Uckan, DDS, PhD,* Sdka Soydan, DDS,Firdevs
Veziroglu, DDS, PhD, and Ayca Arman Ozcrpc

Horizontal sliding osteotomy was first described by
Hofer in 1942.
Converse in 1950 discussed the feasibility of bone
grafts introduced through intraoral approaches.
Trauner and obwegeser in 1957 used the horizontal
osteotomy through an intra-oral incision with
degloving of the anterior mandible.


Converse and Wood Smith described various
application for, as well as the versatility of the
horizontal osteotomy.
Reichenbach and colleauges proposed Wedge
osteotomy and vertical shortening of the chin.
In 1969 Hinds and Kent described the importance of
the soft tissue attachment along with the inferior
segment and role of these attachment in achieving
maximal soft tissue change.
HORIZONTAL OSTEOTOMY OF SYMPHYSIS


Indications: All types of
skeletal abnormalities of
chin
Incision: labial vestibule
to its depth & extends
posteriorly to the 1
st

premolar.




Fragment stabilized by
unicortical or bicortical wires
bone plates
prebent chin plates
lag screws
Obwegeser
modification





Midsagittal osteotomy of inferior
fragment is helpful in preventing
the prominence of the posterior
ends of the fragment, relative to
body of mandible as fragment is
advanced

A narrow chin point can also be obtained by taking a
wedge of bone from the lingual aspect of the cut
.
Overlapping an advanced inferior fragment on the
lateral cortex of the symphysis allows both an
increase in horizontal prominence as well as a
decrease in the anterior mandibular vertical height
Larger advancements of the inferior fragments can be
obtained by double or triple osteotomies, rotation of
fragment combined with a graft at the posterior gap&
bone graft between the symphysis and the fragment
One of the main critiques of the sliding osteotomy is the
hourglass esthetic deformity seen in the frontal view
J Oral Maxillofac Surg68:931-934, 2010


A, B, Frontal and profile views post-
sliding horizontal osteotomy
genioplasty.
The hourglass deformity seen in
the frontal view and the notching
with soft tissue jowling in the profile
view.


Stephen A. Schendel. Sagittal Split
Genioplasty. J Oral Maxillofac Surg 2010.
Horizontal osteotomy with anteroposterior reduction
Horizontal chin excess is treated by moving the inferior
fragment posteriorly. at times it is necessary to remove the
posterior ends of inferior fragment to prevent unsightly
protrusion from the inferior portion of mandible.
When the patient has normal facial height, the plane of the
osteotomy should parallel the F-H plane, then anterior chin
projection can be reduced by parallel/ v-shaped osteotomies in
vertical plane, with middle segment removed.
Vertical Reduction Genioplasty
Vertical symphysis excess can be reduced by removing middle
segment of bone when the plane of 2 parallel osteotomies is
more horizontal
Previous design also permits the correction of mild horizontal
deficiency that is combined with a mild vertical excess
Above mentioned skeletal problem can also be corrected by
making a single osteotomy more vertical& moving the segment
anteriorly& forward
Vertical Augmentation
Vertical symphyseal deficiency managed only by some type of
interpositional material with either bone grafts or implants
Silicone chin implants
Correction of asymmetry of chin
Done in unilateral condylar hyper or hypoplasia
where the chin is deviated.
Done for the lateral movement of the chin
Also known as propeller osteotomy
First osteotomy is performed parallel to the
inter pupillary line
Second osteotomy is performed parallel to the
lower border of the chin

Altering the anterior dimension
For narrowing the anterior dimension of chin a
midline ostectomy is performed at the centre and this
part is removed
Lateral segments are moved medially
For widening the anterior dimension of chin
osteotomy is performed in the centre of the chin
fragment
After increasing the width bone graft is placed
between the segments






Sagittal Split Genioplasty: A New Technique
Stephen A. Schendel, MD, DDS
Orientation of the reciprocating saw
for the sagittal sliding genioplasty.
The saw is first oriented as vertical as
possible with the blade in the sagittal
sense lateral to the bicuspid teeth.
below the mental foramen and the
blade exits at the inferior border in this
region.
.
The saw is then carried forward in the
sagittal plane until the area mesial to the
cuspid is reached.
At this point the saw blade is curved into
a horizontal position as its cuts and the
remainder of the osteotomy is completed
in the usual horizontal manner as shown.
This results in a sagittal split of the lateral
one third to two thirds of the inferior
chin segment


Lateral facial view
demonstrating the change that
occurs with advancement of
the inferior chin segment in
the sagittal split genioplasty.
Similar to the sagittal split
ramus osteotomy after
advancement of the tooth
bearing, no through and
through gap is created.


Stephen A. Schendel. Sagittal Split
Genioplasty.
J Oral Maxillofac Surg 2010.
SOFT TISSUE CHANGES INDUCED BY
SURGERY
The maintaining of soft tissue attachment given movements
predictably (ELLIS III; DECHOW; McNAMARA et al.,
1984)
The realization of genioplasty to advances result in 1:1
proportion to soft tissues repercussion (BELL;
BRAMMER; McBRIDE, 1981 and BELL, 1981).
Positions analyzes of hard and soft tissues of chin when the
advances genioplasty performed simultaneous mandible
advances and Le Fort I osteotomy in a ratio of 0,85:1 to
alterations of soft tissue chin (BELL; GALLAGHER,
1983).


Long-term skeletal and soft-tissue responses after
advancement genioplasty
Stefan Shaughnessy, Karim A. Mobarak, Hans Erik Hgevold
and Lisen Espelandd Hokksund and Oslo, Norway
(Am J Orthod Dentofacial Orthop 2006;130:8-17)

Introduction: The objectives of this cephalometric study were to
assess the skeletal stability of advancement genioplasty 3 years after
surgery and to evaluate the predictability of soft-tissue changes.
Methods: The subjects comprised 21 consecutive patients who had
no additional orthognathic surgical procedures. Lateral cephalograms
were taken at 5 times: immediately preoperative, immediately
postoperative, 6 months postoperative, and 1 and 3 years
postoperative.


Results: Mean surgical advancement at pogonion was 8.4 mm. Three
years after surgery, mean relapse at pogonion was 8% of the surgical
advancement. Part of this change was most likely due to bone
remodeling. No patient demonstrated a clinically significant
postoperative change at pogonion.
The soft tissue of the chin was found to follow bony movement in a
ratio of 0.9:1. Great individual variability was observed.

The mentolabial fold depth increased as a result of the treatment.
Effects of advancement genioplasty on the lips were small.

Conclusions: A prediction ratio based on long-term skeletal changes
is likely to generate an estimate that is more appropriate to present
to the patient.


Bleeding.
Hemorrhage causing lingual hematoma and
possible airway compromise
Prolonged neurosensory disturbances
Avascular necrosis of mobilized segments


Unaesthetic soft tissue changes such as chin
ptosis
Excessive lower tooth display
Bony resorption under alloplasts
Devitalisation of teeth
Mandibular fracture
Asymmetry and an unaesthetic end result

REFERENCES
Peterson s- principles of oral and maxillofacial surgery-
2
nd
edition
Historical developments of orthognathic surgery. E. W.
Steinhauser. Journal of cranio-Maxillofacial surgery. 1996:
24 : 195 204.
Mandibular procedures. Fonseca . Orthognathic surgery.
Text book of oral and maxillofacial surgery.


Surgical Correction of Dentofacial Deformities. Bell, Profitt
and White.
Essentials of Orthognathic Surgery by Johan P. Reyneke
Maxillofacial surgery 2
nd
Edition : Peter Ward Booth
Textbook of Oral and Maxillofacial Surgery. Gustav O.
Kruger



God grant me the serenity to accept
the things I cannot change, the
courage to change the things I can,
and the wisdom to know the
difference.