Osseous Genioplasty: Prevention of Witch’s Chin Deformity with No-Degloving Technique

Zhang, Ben; Byrd, Rosemarie; Bradley, C. M.; Volpicelli, Elizabeth J.; Gibstein, Alexander; Fisher, Mark; Lee, Justine C.; Bradley, James P.

doi:10.1097/prs.0000000000008478

Cited by 6 publications

(3 citation statements)

References 21 publications

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“…First, subperiosteal dissection should stop at the posterior margin of the base of the mandible to preserve soft tissue contact with the lingual cortex as much as possible. 3 , 10 Second, suspension of the soft tissue chin pad superior to its original position with the bone tunnel is critical to prevent the descent of soft tissue. Third, submental liposuction is needed for patients who have developed excess submental soft tissue.…”

Section: Discussionmentioning

confidence: 99%

Coronal-splitting Reduction Genioplasty Combined with Bilateral Osteotomies of the Mandibular Inferior Border for Macrogenia

Hirohi

2024

Plastic and Reconstructive Surgery - Global Open

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Summary: There are various types of chin deformities, and the least established surgical method for deformity correction may be reduction for anteroposterior macrogenia. Anteroposterior macrogenia is commonly corrected by either setback genioplasty or burring reduction, but these approaches are less likely to produce aesthetically pleasing results. Both procedures have poor reduction effects because of the low response rate of soft tissues to skeletal alterations. There is a high likelihood of chin ptosis and flattening. Setback genioplasty can also yield step deformities at the inferior mandibular border. To overcome these drawbacks of conventional methods, I developed a novel technique of coronal-splitting reduction genioplasty. I have performed more than 83 procedures with a high success rate over the past 10 years. Alloplastic chin implant-shaped bone fragments were resected from the prominent bony chin, in which the average thickness of resected bone was 8.2 mm. Sufficient sagittal reduction effects were then achieved in most cases, although the soft tissue response rate remains 25%–50%, as reported in the literature. The no-degloving technique with cephalic suspension of the mentalis muscle prevents chin ptosis. Combined bilateral oblique osteotomies of the inferior mandibular border contribute to minimizing obvious postoperative chin flattening. Moreover, macrogenia can be large in multiple planes, including anteroposterior, vertical, transverse, or their combinations. This new technique can handle all three planes by combining both bilateral oblique osteotomies of the inferior mandibular border and burr ostectomy. Overall, these findings suggest that the coronal-splitting genioplasty method may replace conventional methods for correcting macrogenia.

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Section: Discussionmentioning

confidence: 99%

Coronal-splitting Reduction Genioplasty Combined with Bilateral Osteotomies of the Mandibular Inferior Border for Macrogenia

Hirohi

2024

Plastic and Reconstructive Surgery - Global Open

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“…Zhang et al also asserted that witch's chin and soft-tissue ptosis can be decreased by nodegloving technique. 26 Sixth, the routes of the alveolar and mental nerves were checked carefully by radiography. The hairpin shape of the alveolar nerve ending must be especially prudently examined before surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Zhang et al also asserted that witch’s chin and soft-tissue ptosis can be decreased by no-degloving technique. 26 …”

Section: Discussionmentioning

confidence: 99%

Soft tissue response following genioplasty combined with anterior segmental osteotomy

Kim¹,

Han²

2023

Plastic &Amp; Reconstructive Surgery

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Genioplasty is an excellent adjunctive procedure that can be performed with other maxillofacial operations 1 because of its predictability and stability. [1][2][3][4][5][6][7][8][9][10][11] Postoperative results generally satisfy patients, with few complications. 2,12 However, genioplasty alone is not sufficient to correct chins combined with bimaxillary protrusion. Anterior segmental osteotomy (ASO) is frequently performed in Asian patients with bimaxillary dentoalveolar protrusion. 13,14 The advantages of this procedure are dramatic change, fast results, and minimal relapse, compared with orthodontic treatment. 14,15 Soft-to hard-tissue ratios are essential for predicting soft-tissue response in genioplasty. According to a systematic review of soft-to hardtissue ratios of the chin in orthognathic surgery, 16 the horizontal ratio at pogonion (Pog) ranged from −0.27:1 to −0.70:1 (mean, 0.52:1) in setback genioplasty, and from 0.53:1 to 0.99:1 (mean, 0.85:1) in advancement genioplasty. The vertical Background: The authors' main aim was to analyze soft-tissue response of the chin following genioplasty with anterior segmental osteotomy, which enables optimal surgical planning of genioplasty. Methods: Sixty-two patients who underwent genioplasty with concomitant anterior segmental osteotomy were divided into three groups depending on the direction of pogonion (Pog) movement: G1 (without sagittal change), G2 (advancement genioplasty), and G3 (setback genioplasty). All genioplasties included height reduction. Hard-and soft-tissue measurements with cephalometry were performed at T1 (before surgery), T2 (after surgery), and T3 (after orthodontic treatment) for the analysis of sagittal and vertical changes. Correlation and regression analyses were conducted to analyze soft-to hard -tissue movement and soft-tissue thickness changes. Results: During the T1 to T2 period, the horizontal soft-to hard-tissue ratio at Pog was 0.85 in G2 and 0.80 in G3, and the vertical ratio at menton (Me) was 0.9 for all groups. The correlation coefficients were 0.64 (G2) and 0.83 (G3) at Pog and 0.9 (all), 0.85 (G1), 0.95 (G3) at Me. There was no significant correlation between initial soft-tissue thickness and soft-tissue response ratio. During the T2 to T3 period, no significant relapses were observed, which demonstrates the stability of anterior segmental osteotomy combined genioplasty. Conclusions: Clinically and statistically significant soft-tissue responses were demonstrated at Pog and Me. The higher values in G3 in particular suggest that setback genioplasty with anterior segmental osteotomy is an effective treatment alternative to conventional two-jaw surgery in some patients with bimaxillary prognathism with macrogenia.

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Redundant Chin Soft Tissue Treatments: Witch’s Chin and Double Chin Deformities

Kim

2024

Handbook of Oral and Maxillofacial Surgery and Implantology

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Osseous Genioplasty: Prevention of Witch’s Chin Deformity with No-Degloving Technique

Cited by 6 publications

References 21 publications

Coronal-splitting Reduction Genioplasty Combined with Bilateral Osteotomies of the Mandibular Inferior Border for Macrogenia

Coronal-splitting Reduction Genioplasty Combined with Bilateral Osteotomies of the Mandibular Inferior Border for Macrogenia

Soft tissue response following genioplasty combined with anterior segmental osteotomy

Redundant Chin Soft Tissue Treatments: Witch’s Chin and Double Chin Deformities

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