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2011 Annual Meeting Abstracts

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Michael J. Yaremchuk, M.D., Chad R. Gordon, D.O..
Harvard Medical School, Boston, MA, USA.

PURPOSE: Iatrogenic deformities including excessive lower incisor show, lower lip incompetence, a deep labial sulcus, and chin ptosis are not uncommon following primary osseous or alloplastic genioplasty. A 25-year clinical experience with facial-skeletal surgery has led to the recognition of the above-described problems, means to avoid them, and methods for correction.
METHODS: A retrospective review of consecutive genioplasties performed over a 5-year period by a single surgeon was performed. These include 27 patients presenting for post-genioplasty deformity correction and 159 patients presenting for primary genioplasty.
Primary genioplasty-All primary genioplasties, both osseous and alloplastic, were performed through a submental approach with extensive subperiosteal exposure of the chin and anterior mandible. All implants and osteotomized segments were rigidly fixed. Implant design assured a smooth transition between the superior aspect of the implant and native mandible during alloplastic genioplasty. The osteotomy-native mandible interface was smoothed during osseos genioplasty. The appropriate postion of the chin pad relative to the skeleton was assured prior to wound closure.
Secondary genioplasty-24 of the 27 (89%) of patients presenting for correction of iatrogenic lip-chin deformities had their original surgery performed through intraoral access.
Surgical correction included:1)submental access; 2)subperiosteal release of all chin and anterior mandible soft tissues up to the tooth roots from underling bone or implant (freeing of the soft tissues from any abrupt implant-chin interface or osteomy crevice often resulted in immediate elevation of the lower lip); 3)the mentalis muscle is resuspended to the level of the tooth roots using a Mitek anchor; and 4)if necessary, the chin pad is re-attached with a suture to either the implant or to the native bone using a drill hole.
Primary genioplasty - None of the patients in this series developed lip-chin deformities following alloplastic or osseous genioplasty.
Secondary genioplasty - Surgery was successful in improving iatrogenic lip-chin deformities in 23 of 27 patients (85%). Surgery was repeated in one patient to provide further lip elevation (1/27,4%). Two patients underwent a second operation to have their lip lowered (2/27,7%). One patient with a previous history of infection had secondary surgery complicated by infection and subsequent treatment failure (1/27,4%).
CONCLUSIONS: 1)Iatrogenic lip-chin deformities are more likely when: a)an intraoral approach is used (presumably due to mentalis muscle damage or origin disruption with subsequent descent); b)chin pad soft tissues adhere to either abrupt implant-chin or abrupt osteotomy site transitions thereby effectively decreasing lower lip length; and c)appropriate chin pad-skeletal relations are not assured at wound closure. 2)Iatrogenic chin-lip deformities can be avoided by: a)using a submental approach (thereby avoiding mentalis damage); b)avoiding abrupt transitions; and c)assuring proper chin pad-skeletal relations.
3)Iatrogenic lip chin deformities can be corrected by; a)repositioning the mentalis through submental access and using anchor fixation; b)releasing adherent soft tissues; c)correcting any abrupt implant-skeleton or osteotomy transitions; and d)repositioning and fixating, if necessary, the chin pad to the skeleton or implant.

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