I often prefer to do a sliding or “jumping” genioplasty to correct this. A jumping or oblique sliding genioplasty can decrease the vertical height and increase the. Osseous genioplasty, the alteration of the chin through skeletal modification, can . the requirement—advancement (sliding/jumping), pushback, sideways—and. Additional degrees of freedom can be obtained by using a jumping genioplasty. • Reduction genioplasty is every bit as difficult as augmentation genioplasty.
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Henry Kawamoto, Craig A. Foster, Hale Tolleth, S. The first patient is a year-old woman who complains about an excessively large chin Figure 1, A and B. She has already undergone fairly extensive orthodontic therapy to convert a class III malocclusion to a class I occlusion Figure 1, C.
AFront and Blateral views of a year-old woman whose chief complaint is a prominent chin.
Osseous genioplasty: A case series
CCephalogram shows an orthodontically compensated class III malocclusion. DHorizontal osteotomy of symphyseal region with posterior displacement of segment. Shaded area is removed after setback. EWedge removal with oblique osteotomy to remove excess symphyseal bone and a cephalad-posterior setback of segment. FHorizontal wedge resection with diverging cuts to remove. I have found this problem very difficult to genioplqsty.
The temptation here would be to simply remove some of the bony prominence with a burr via a degloving approach. Although this approach has been used by some plastic surgeons, it can produce unpredictable results. If the soft tissue envelope doesn’t contract and adhere properly, chin ptosis and unevenness may result, an outcome even more difficult to correct than the original deformity.
A better approach would be to osteotomize the chin and set it back with some bone removal, preserving the attachment of chin pad and musculature to the bone Figure 1, D. The patient’s genioplasy is a bit jumoing the full side, and moving the chin back is not going to improve her neck. Tolleth, what do you think? First of all, this patient has an excessively long lower face, and would benefit from shortening.
So my inclination would be to perform a chin reduction procedure by osteotomizing the chin and setting it back and shortening it at the same time Figure 1, E. I would direct the osteotomy to obtain a little bit more posterior movement.
I would consider liposuction or direct removal of fat in the cervicomental angle region. Tolleth said that she had a long lower facial third, but I believe some of the problem may be in the middle third.
It will rotate her mandible down and give her a little more fullness. When her lips are in repose, she shows no teeth. Lengthening the maxilla would be my first choice for her. To some people this sounds like a big operation, but it’s really not that much more than some of the other options. Now, if she absolutely refused to have that done, I would agree with Dr.
I would reduce her chin by taking 3 or 4 mm out anteriorly, taking a central strip and preserving the lower border, and then taking a larger dimension posteriorly Figure 1, F. Looking at the cephalogram, the gdnioplasty tissue pad is enormous. Would anybody tackle the soft tissue and leave the bone as is?
The only ones that I’ve ever seen were jumpung disaster. It is not difficult to remove some soft tissue, but it is really difficult to get a chin that doesn’t have patches, dimpling or irregularities when the patient smiles or moves his or her mouth.
What about the relationship of her lower lip to the projection of the chin? How far would you set the chin back? I like to have the chin line up along the vertical dropped from the lower lip. I don’t want the chin point in front of the vertical line from the lower lip, and this patient’s is a little too anterior. The second patient is a year-old high school student who wants more of a chin Figure 2, A and B.
Reduction Rhinoplasty | Sliding Genioplasty
As you can see on the cephalogram Figure geniollasty, Cshe has undergone orthodontic treatment to a class I occlusion. The soft tissue of the chin pad is more cephalad than the anterior point of the chin itself. She has lip strain with pulling up of the chin pad to get lip seal.
Wolfe, how would jummping treat this patient? AFront and Blateral views of a year-old girl who desires more projection of her chin. CCephalogram shows a small mandible with a class I occlusion.
EDouble-step osteotomy maximizes anterior projection of the chin. This girl has a mentalis bump that’s midway up her chin. Some people might confuse this for the lower border of the chin. She actually has ujmping very long chin, and the lower border is much further down.
Finesse in Genioplasty | Aesthetic Surgery Journal | Oxford Academic
And on the front view, she shows characteristic straining of the mentalis just to get her lower lip up. This shortens the chin and gives more projection of the lower border.
This procedure would very likely help this patient tremendously with her lip seal problem. Yes, you can get jumpjng to 12 mm. The upper limit for a sliding genioplasty is 6 to 8 mm, but you can get a good bit more with a jumping genioplasty. I wouldn’t use either as the primary method for obtaining projection, but rather I would place it behind and around the mobilized segment as a spacer graft to add stability and improve contour.
I believe in a case such as this, with this magnitude of skeletal disharmony, that alloplastic implants don’t seem to work very well.
Why do you say that? You could get a custom-made implant to wrap around the geniopoasty and give you that projection.
I’ve tried wide wrap-around custom implants in some of these cases and haven’t been successful at getting good aesthetic improvement. They all seem too large and inelegant. I would rather advance the chin and use iliac crest bone for added volume.
If you place a bone graft as an interpositional graft in lengthening the chin, which in this particular case you don’t want to do, very little is absorbed. If you want to use autologous tissue as a chin implant, costal cartilage doesn’t resorb the way a bone graft will.
If after I performed a jumping genioplasty it was still deficient 6 months later, I could choose between another genioplasty which might be a sliding genioplasty or placing a costal cartilage graft through an external incision over the lower border and fixing it with screws. I’ve tried double steps a number of times and have been relatively unhappy with the results Figure 2, E. I just don’t do them anymore. The third patient is a year-old woman who had a chin implant placed 4 years ago.
It lacked sufficient projection, so she had another one placed 8 months later Figure 3, A and B. A xeroradiogram taken by the orthodontist shows the implant totally embedded within the bone Figure 3, C. How would you handle this case, Dr. AFront and Blateral views of a year-old woman who had a chin implant placed 4 years ago. Eight months later, it was replaced with another implant. The patient believes she has lost some of the definition of the chin and desires more projection.
CXeroradiogram shows the implant completely embedded in the symphyseal bone.
I think we’ve all seen this. In this particular patient the lack of the labiomental crease is really a substantial cosmetic defect. A simple sliding osteotomy on this patient would probably have solved her problems Figure 3, D. When a chin implant is placed through the mouth, it can ride up more than when placed through a submental incision and will more likely erode the bone. What about the position of this implant?
It seems to me that it has migrated cephalad and is not really over the compact bone of the symphysis. Do you believe the position of the implant has anything to do with the amount of absorption seen? The implant is close to the softer alveolar bone over the roots of her lower incisors, whereas the bone at the very lower mandibular border is harder; actually one of the hardest bones in the body.
I routinely place all chin implants from a submental approach. I believe I can control the positioning and retention of the implant more predictably from this approach.
Intraorally placed implants have a tendency to ride high. I don’t routinely see resorption because I don’t routinely obtain radiograms of these patients. I don’t think it makes any difference whether the implant is placed above the periosteum or below the periosteum, sometimes resorption just happens. I am concerned that were I to perform a sliding advancement genioplasty in this patient, getting another 4 or 5 mm of advancement might actually put her chin point out in front of her lower lip.
An osseous genioplasty is a powerful tool, and it’s very easy to overdo it, as I have done in the past. I’ve learned through my own mistakes that I don’t want to have that lower chin border be in front of the lower lip. I would take the chin implant out and possibly shorten her chin just a bit, maybe about 6 mm, and then advance the lower border slightly to give her a labiomental crease see Figure 1, E.
As we shorten the chin, we’re going to be deepening the labiomental crease. Conversely, when we lengthen the chin, we can soften it. So I would do some slight shortening and a little advancement, and I would be very careful not to place the chin too far forward. I have to disagree with Dr. Wolfe because I don’t believe this patient needs very much shortening, if any.
You could go forward almost 1 cm and still not be in front of the lip.
The chin implant is 5 mm thick, so that if you advanced her genioplaty mm, presumably gaining what was achieved with the original chin implant, then that’s all you would have to do. A 5-mm advance doesn’t seem to me to be very substantial.
For implants that erode through symphysis, Genioplsty have filled the defect with hydroxyapatite block and placed the chin implant back on top of it.
Why not just take the implant out?