Current techniques for three-dimensional correction of the chin in patients with mandibular retrusion may increase mentolabial fold depth, but have limited effect on the lips. The authors present a single surgical technique to support the mentolabial fold and improve labial competence. The visor osteotomy is performed from canine to canine. The bone fragment pedicled to the lingual periosteum is coronally mobilized and fixed in the new position. Preserved vascularization is supposed to minimize the amount of bone resorbed. Visor osteotomy of the anterior mandible may improve the existing treatments for micrognathia by creating an aesthetic mentolabial fold and a competent lip seal.Key Words: Bone graft, mandible, orthognathic surgery F acial aesthetics are among the principal factors in decisions about surgical treatment. Patients with mandibular retrusion or microgenia may benefit from genioplasty, which corrects threedimensional chin position and makes the facial profile less convex.
1Combining genioplasty with sagittal split advancement osteotomy (SSAO) can improve the aesthetic result. [2][3][4][5] Nevertheless, the remodeling pattern in the area of the osteotomy makes the softtissue profile unpredictable. In the postoperative healing period, the scar contraction may result with thin soft tissues.2 Advancing the chin too far can create a marked mentolabial fold and increase softtissue tension.Various surgical techniques have been suggested to avoid chin ptosis, or ''witch-chin. '' 6 Autogenous bone grafting is often used to avoid an excessive mentolabial fold. 7 The lateral wings of the genial segment, however, are prone to resorbtion. Surgeons can improve the facial soft-tissue contouring by using fat. 8 Alloplastic materials were considered preferable for patients who must not activate the mentalis muscle to attain a lip seal. 9 An outer cortex can be split away from the mandible to achieve the natural position of the mentum and the lower lip, but the risk of infection might be higher because the advancement leaves dead space. 10 Hence, we introduce the principle of visor to support the mentolabial fold and improve labial incompetence.
MATERIAL AND METHODS
Clinical ReportAn 18-year-old girl was referred for treatment of micrognathia inferior congenita. Once orthodontic presurgical alignment was done, cone beam computed tomography (eXam-Vision 3D, Imaging Sciences International, KaVo Dental GmbH, Biberach, Germany) was used to determine the quantity of jaw bone and morphology ( Fig. 1A-B). The occlusal plane was corrected by bilateral sagittal split rotation osteotomies. Simultaneously, wing osteotomy was performed to vertically enlarge the mandibular border plane (Fig. 1C-D). 11 Upper wisdom teeth were also extracted. Two years later, the patient was scheduled for visor osteotomy to increase support of the mentolabial fold. The patient signed a written consent form.Surgery was performed under local anesthesia. Mucosa was incised in the vestibulum from premolars to premolars, 0.5 to 1.0 cm ...
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