Facial Skeletal Augmentation With Implants and Osseous Genioplasty

Question 1

The subcutanouse plane is typically preferred for implant
placement.

Answer 1

F The subperiosteal plane is typically preferred for implant
placement.

Question 2

Incisions should be planned away from the implant pocket

Answer 2

T

Question 3

Rigid fixation minimizes the risk ofinfection

Answer 3

Rigid fixation minimizes implant malposition and reduces
risk ofinfection.

Question 4

Horizontal osteotomies should be placed at least 5 mm
caudal to the canines to avoid tooth root injury as well as to
reduce risk of mental nerve injury

Answer 4

T

Question 5

Placement of intraoral incision should be I cm anterior
to the gingivolabial sulcus, allowing for proper wound
closure

Answer 5

T

Question 6

preoperative evaluation

Answer 6

3D CT scanning, stereolithographic modeling, 3D printing posteroanterior and lateral cephalometric radiographs and panoramic x-rays

Question 7

skeletal augmentation with autogenous bone can remodel, in time
affecting its size and shape.

Answer 7

T

Question 8

Implant migration and adjacent bone erosion also tend to be lower in porous implants

Answer 8

T

Question 9

Solid silicone implants offer several advantages

Answer 9

can be effortlessly carved to achieve a desired shape and size,
as well as be easily fixated with screws or sutures.
infection, although low regardless of the implant type, has been reported to be lower when silicone implants are used.

Question 10

Implant placement is described in both supraperiosteal and subperiosteal planes

Answer 10

T

Question 11

The subperiosteal pocket dissection is
preferred why?

Answer 11

The subperiosteal pocket dissection is
preferred as it involves a plane of dissection that is bloodless and safe
relative to surrounding neurovascular structures

Question 12

A major advantage of screw fixation over the other methods
(e.g., sutures) relates to more accurate final contour because gaps
between host bone and the implant are eliminated

Answer 12

T

Question 13

Most aesthetic facial augmentation occurs in the middle and lower
thirds ofthe face

Answer 13

T

Question 14

Augmentation ofthe midface can be divided in four
major areas&raquo_space;»

Answer 14

malar, submalar, paranasal, and infraorbital rim.

Question 15

skeletal augmentation are equivalent to
soft-tissue augmentation and resuspension;

Answer 15

F skeletal augmentation should not be seen as equivalent to
soft-tissue augmentation and resuspension; these are two separate entities that when used appropriately can have a synergistic effect

Question 16

Incision placement for insertion of malar implants can vary and
include the intraoral, coronal, or eyelid routes

Answer 16

T

Question 17

Careful carving ofthe implant on its posterior surface and
rigid fixation minimize visibility and malposition

Answer 17

T

Question 18

In patients with
a relatively normal occlusion, deficient midface projection can be corrected with facial implants

Answer 18

T

Question 19

When properly placed, paranasal implants
can simulate the visual effect ofLeFort II advancement

Answer 19

F of LeFort I advancement

Question 20

the upper gingivalbuccal sulcusincision
is made just lateral to the piriform aperture

Answer 20

T

Question 21

When screw fixation is employed, care
should be taken to avoid the root ofthe canine

Answer 21

T

Question 22

Compromise ofthe nasal
airway can occur ifimplants are positionedover the piriform aperture.

Answer 22

T

Question 23

Augmentation of the infraorbital rim can decrease
the incidence of lower lid malposition by reversing the “negative”
vector

Answer 23

T

Question 24

Better exposure ofthe midface skeleton can be obtained by incorporating an intraoral sulcus incision

Answer 24

T

Question 25

Prior to closure, malar soft tissue should be resuspended over the secure implant

Answer 25

T

Question 26

The deepest portion of the temporal fossa is the anterior inferior fossa, which is the sphenoid bone contribution

Answer 26

T

Question 27

If a previous reconstructive surgery was performed in the temporal area, access is gained through the old scar and the PMMA is placed over the deficient muscle.

Answer 27

T

Question 28

Ifpatients have not had surgery or have had the temple used as a remote access to other regions of the face (i.e., subperiosteal facelift), then the implant is placed beneath the temporalis muscle though an incision in the temporal hair-bearing scalp

Answer 28

T

Question 29

In an ideal face, the upper lip should be projecting 2 mm beyond the lower lip,

Answer 29

T

Question 30

the lower lip should be projecting the same distance beyond the chin

Answer 30

T

Question 31

Riedel's line is a rapid means of assessing the adequacy of chin projection.

Answer 31

T

Question 32

Men tend to have larger, more projected chins compared to women

Answer 32

T

Question 33

An ideal chin implant is one that augments the mentum while merging laterally with the anterior aspect of the mandibular body

Answer 33

T

Question 34

Extended porous implants have limited flexibility and are typically designed in two pieces to allow placement through a reduced incision

Answer 34

T

Question 35

the submental incision for Chin implant is more commenly used

Answer 35

T

Question 36

intraoral incision draw backs?

Answer 36

limited exposure of the anterior mandible. associated with superior malposition of the implant soft-tissue ptosis

Question 37

This is usually secondary to improper mentalis muscle repair at the time of wound closure and results in a witch's chin deformity.

Answer 37

T

Question 38

chin augmentation remains the most popular type of mandibular augmentation

Answer 38

T

Question 39

A suction drain is usually placed in the operative site which exits through the postauricular area in mandibular augmentation

Answer 39

T

Question 40

Serious complications after alloplastic augmentation of the facial skeleton are rare

Answer 40

T

Question 41

Alloplastic implant complicationsinclude infection, migration, malposition, and asymmetry Bone resorption

Answer 41

T

Question 42

. Bone resorption of adjacent areas has been reported and is associated with solid implants. Bone resorption is significantly less likely with porous implants

Answer 42

T

Question 43

The total reoperation rate was 10% and mostly due to implant malposition, asymmetry, or displeasing contours

Answer 43

T

Question 44

If implant infection does occur, antibiotic treatment alone is usually sufficient.

Answer 44

F If implant infection does occur, antibiotic treatment alone is usually not sufficient. In such cases, implant removal is recommended along with an antibiotic regimen. Implants can be replaced at 12 months after infection cessation

Question 45

The horizontal genioplasty remains as the second most commonly performed osteotomy of the facial skeleton, next to rhinoplasty

Answer 45

T

Question 46

Compared to prosthetic chin implants, osseous genioplasty allows for a more powerful and versatile alteration of chin morphology and shape.

Answer 46

T

Question 47

This includes not only correction of sagittal deficiency, but also can includevertical lengthening, reduction, and correction of asymmetries.

Answer 47

T

Question 48

muscles that attach to the anterior plane of the chin

Answer 48

mentalis, depressor angularis, and depressor labii inferioris

Question 49

muscle attachments on the lingual aspect of the chin

Answer 49

include mylohyoid, geniohyoid, and genioglossus.

Question 50

It is the latter group that contains the perforating branches responsible for maintaining blood supply of the caudal chin segment following elevation of the anterior periosteum and horizontal osteotomy

Answer 50

T

Question 51

To avoid injury to the mental nerve, the horizontal osteotomy should be planned at least 5 mm caudal to the foramen in a caudal-oblique angle.

Answer 51

T

Question 52

Those favoring alloplastic augmentation over osseous genioplasty cite several theoretical advantages including

Answer 52

technical ease, less pain, and a relatively low complication risk.

Question 53

Advatage of genolasty aver soft tissue implants

Answer 53

the horizontal genioplasty offers potential correction in multiple planes, anterior, posterior, and vertical Alloplastic augmentation with chinimplants can be effective in correcting mild to moderate volume deficiencies in the sagittal plane Major limitations of alloplastic methods occur when trying to correct vertical excess or any asymmetries of the anterior mandible osseous genioplasty is more amenable to surgical revision if such a condition is indicated soft tissue of the chin has not been degloved and there is no scar capsule formation to address

Question 54

genuiplasty should not be seen as a replacement to orthognathic surgery

Answer 54

T

Question 55

The distance from the stomion to the menton should be twice the length of the distance between the subnasale and the stomion.

Answer 55

T

Question 56

The lower lip, and not the other structures in the mid and upper face, determines the extent to which the chin should be advanced

Answer 56

T

Question 57

When advancing the chin, the ratio of soft tissue to skeletal displacement is generally 3:2

Answer 57

T

Question 58

the response ofsoft tissue to a posteriorly repositioned chin is less predictable and typically O.5:l

Answer 58

T

Question 59

Labiomental groove depth should also be evaluated when determining if a patient is a good candidate for osseous genioplasty what the normal measurments

Answer 59

4 mm in women and 6 mm in men.

Question 60

Sagittal advancement or vertical shortening of the symphyseal segment would result in softting of the labiomental groove

Answer 60

f Sagittal advancement or vertical shortening of the symphyseal segment would result in deepening of the labiomental groove

Question 61

In the setting of a long lower face and a deep labiomental fold, correction should include orthognathic surgery rather than osseous genioplasty alone

Answer 61

T

Question 62

The majority ofindividuals requesting aesthetic enlargement ofthe chin have class II malocclusion secondary to mandibular retrognathia

Answer 62

T

Question 63

Although prior orthodontic treatment can convert class II malocclusion into type I, it corrects the underlying skeletal problems

Answer 63

T

Question 64

Routine workup includes a lateral cephalometric and panoramic x-ray and frontal, profile, and oblique photographs at a minimum.

Answer 64

T

Question 65

Maintaining a 1 cm cuff of mucosa and mentalis in the gingival side of incision will facilitate later muscle repair and incision closure

Answer 65

T

Question 66

Complete degloving of the symphysis is not preferred as reattachment of soft tissues can be unpredictable, increasing the risk for a witch's chin deformity.

Answer 66

T

Question 67

The limit of dusection

Answer 67

Exposure is carried laterally until both mental nerves are visualized and posteriorly to the inferior border of the mandible, but not further

Question 68

if vertical elongation is needed, interposing blocks of bone substitute can be inserted into the osteotomy gap previously created.22·23 A gap of less than 5 mm needs no interposition implant

Answer 68

T

Question 69

Mentalis muscle is then reattached using interrupted sutures, a crucial step in preventingsoft-tissue ptosis and a witch's chin deformity.

Answer 69

T

Question 70

Wound dehiscence and infection are rare after osseous genioplasty

Answer 70

T

Question 71

In the setting of a dehiscence without infection and with no loose or exposed hardware, most resolve without intervention

Answer 71

T

Question 72

If infection is suspected and bone fixation is not loose, localized debridement and irrigation followed by antibiotics serve to avoid unnecessary removal of hardware

Answer 72

T

Question 73

More than half of all patients undergoing osseous genioplasty will have some degree of temporary neurosensory loss

Answer 73

T

Question 74

Dental complications can also occur

Answer 74

T

Question 75

Tooth devitalization is probably one of the most serious complications after osseous genioplasty and can be avoided by placing the osteotomy at least 30 mm caudal to the occlusal edge of the mandibular canines

Answer 75

T

Question 76

Tooth devitalization is probably one of the most serious complications after osseous genioplasty and can be avoided ,how you can aviod it ?

Answer 76

can be avoided by placing the osteotomy at least 30 mm caudal to the occlusal edge of the mandibular canines

Question 77

Soft-tissue ptosis is usually secondary to improper mentalis muscle repair at the time of wound closure and results in a witch chin's deformity

Answer 77

T

Question 78

It can be corrected by excising soft tissue through an elliptical incision in the submental area

Answer 78

T

Question 79

Lower lip retraction resulting in increased lower incisor show can also occur secondary to improper mentalis muscle repair

Answer 79

T

Question 80

Lower lip retraction correction

Answer 80

Correction can be achieved through an intraoral incision and cephalically suspending anterior periosteum

Question 81

Using a submental incision for alloplastic augmentation genioplasty may reduce risk of infection, wound dehiscence, and implant migration.

Answer 81

T

Question 82

An ideal implant material is one that is biocompatible and has minimal interaction with the surrounding tissues, such that its morphology is maintained after placement

Answer 82

T

Question 83

Screw fixation in paranasal implant minimizes asymmetries and malposition

Answer 83

T

Question 84

Riedel's line is a rapid means of assessing the adequacy of chin projection. A line is drawn tangential to the upper lip and lower lip and the chin should fall on this line

Answer 84

T

Question 85

An intraoral mucosa! incision provides adequate exposure of the mandibular ramus and body in the subperiosteal plane

Answer 85

T

Question 86

If extensive anterior movement of the chin segment is anticipated, it might be necessary to detach the anterior belly of the digastric muscles from the lingual surface

Answer 86

T

Question 87

For vertical shortening of the chin, two parallel horizontal osteotomies with removal of the intervening bone segment are used. The inferior cut is always made first for ease of handling.

Answer 87

T

Question 88

Root exposure can occur if incision is placed too close to the gingiva and is most likely in patients with gingival resorption

Answer 88

T

Question 89

Horizontal osteotomy should be performed using a reciprocating saw at least 4 mm below the mental foramina in order to avoid nerve injury.

Answer 89

T