KEY NOTES CHAPTER 9: AESTHETIC SURGERY - Genioplasty.

Question 0

Genioplasty: examination.

Answer 0

• chin to lower lip relationship
• lower facial height
• asymmetry
• depth of labiomental fold
• teeth occlusion, inclination of incisors, tooth decay.
  Males: wide, square prominent chin, 2-point light reflex.
  females: single-point light reflex.

Question 1

What is important in the history?

Answer 1

What they dislike.

Any orthodontic work (may conceal Class II malocclusion in micrognathia).

Question 2

How do you classify types of genioplasty?

Answer 2

Alloplastic augmentation.
Osseous genioplasty.

Approaches:

1. Submental.
2. Intraoral buccal sulcus.

Question 3

Tell me about alloplastic augmentation.

Answer 3

Suitable for mild-moderate deficiency.
Difficult to address asymmetry or vertical height.
Materials: silastic, Medpor, Gore-Tex.

Submental: less risk of cephalic implant migration, infection and lip ptosis.

Complications:

• deepens labiomental fold.
• mandible erosion.

Question 4

Tell me about osseous genioplasty.

Answer 4

Sliding-advancement genioplasty
- can correct chin deficiency, asymmetry, vertical height and adjust labiomental fold.

Technique

• buccal sulcus incision, through mentalis.
• horizontal osteotomy (~4mm inferior to mental foramina to protect inferior alveolar nerves).
• reposition bone, wires or plate and screw fixation.
• use interposition bone graft substitute for vertical elongation.
• repair mentalis to avoid lower lip incompetence and chin ptosis (witch’s deformity).

Question 5

What are the complications of genioplasty?

Answer 5

• lower lip parasthesiae
• soft tissue / bony infection
• dental root injury
• haematoma
• undesirable cosmetic result.
  Alloplastic: migration of implant, mandibluar erosion, extrusion.