10.59987/ads/2015.3-4.110-112
Aim. The aim of this study was to determinate how orthognatic surgery aids to cure many skull and face abnormalities and to help re-establishing the correct occlusive relation thanks to the repositioning of the maxillo-mandibular skeleton basis.
Methods. The study included 183 male patients and 338 female patients, with an average age of 23 years. The sample series was divided according to specific pathologies. All patients underwent surgical procedures and the therapeutic strategy was determined based on the anomalies presented.
Results. 113 patients had a II class dental skeletal occlusion, 180 patients had a III class dental-skeletal occlusion and 222 patients had skull-facial abnormalities. 5 patients underwent only a genioplasty, 82 patients underwent a genioplasty associated with BSSO, 175 patients underwent a genioplasty associated with Le Fort I osteotomy and the remaining 253 patients underwent a genioplasty associated with BSSO and Le Fort I osteotomy.
Conclusion. The experience shows that genioplasty has been successfully introduced in orthognathic surgical therapeutic procedures, for dental-skeleton abnormalities and mandibular asymmetries treatment. In recent years, the evolution of computer systems has allowed an accurate assessment and programming, by means of the three-dimensional display, which are of great help in the course of diagnosis and evaluation of the displacements to be carried out, in order to obtain optimal aesthetic results
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Annali di stomatologia
facial profile change
 Aesthetic restoration in maxillo-mandibular malformations: the role of genioplasty
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Original Article
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2015
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Department of Maxillo-Facial Surgery, Policlinico Umberto I, “Sapienza” University of Rome, Italy
1971-1441
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facial profile change
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112
 Aesthetic restoration in maxillo-mandibular malformations: the role of genioplasty
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                                                                                                    Original article



    Aesthetic restoration in maxillo-mandibular
    malformations: the role of genioplasty




                                                                                                      i
                                                                                                    al
                                                                                                 on
    Claudio Ungari MD, PhD1                                 three-dimensional display, which are of great help
    Emiliano Riccardi, MD2                                  in the course of diagnosis and evaluation of the
    Gabriele Reale, MD, PhD2                                displacements to be carried out, in order to obtain
    Alessandro Agrillo, MD1                                 optimal aesthetic results.
    Claudio Rinna, MD1




                                                                                       zi
    Valeria Mitro, MD2                                      Key words: orthognathic surgery, plastic surgery,
    Fabio Filiaci, MD, PhD2                                 genioplasty, maxillo-mandibular malformations,
                                                            facial profile change.




                                                                         na
    1   Department of Oral and Maxillo-Facial Sciences,
        “Sapienza” University of Rome, Italy                Introduction
    2   Department of Maxillo-Facial Surgery, Policlinico
                                                            Many adult patients consult an orthodontist and/or




                                                              er
        Umberto I, “Sapienza” University of Rome, Italy
                                                            maxillofacial surgeon wanting to improve their facial
                                                            and dental aesthetics because beauty has great so-
    Corresponding author:                                   cial power and results in more social contacts (1). Or-
    Emiliano Riccardi


                                                      t     thognathic surgery was performed in order to correct
                                                   In
    Department of Maxillo- Facial Surgery, Policlinico
    Umberto I, “Sapienza” University of Rome
                                                            several skull and face abnormalities. It aims to restor-
                                                            ing a correct occlusive relation, though the reposition-
    Via Valentino Banal, 31                                 ing of the maxillo-mandibular skeleton basis, to in-
    00177 Rome, Italy                                       crease in balance the stomatognatic system with neu-
    E-mail: emiliano.riccardi@hotmail.it                    ro-muscular and articular components. Furthermore,
                                        ni
                                                            while restoring the dental-skeletal relation and the oc-
                                                            clusive ratio, it significantly helps to harmonize the
    Summary                                                 face contour, achieving great cosmetic results (2).
                                io

                                                            Nowadays, orthognathic surgery can be associated to
    Aim. The aim of this study was to determinate how       other surgical treatments, such as either reductive and
    orthognatic surgery aids to cure many skull and         augmentative genioplasty (3). In 1942, Hofer first re-
    face abnormalities and to help re-establishing the      ported the use of genioplasty as surgical intervention,
                        iz



    correct occlusive relation thanks to the reposition-    performing an anterior horizontal mandibular osteoto-
    ing of the maxillo-mandibular skeleton basis.           my; later on, in 1947, Sir Harold Gillies performed a
    Methods. The study included 183 male patients and       sliding genioplasty on a patient affected by the Treach-
           Ed




    338 female patients, with an average age of 23          er-Collins syndrome. Finally, in 1964 Convers and
    years. The sample series was divided according to       Wood-Smith published their first significative literature.
    specific pathologies. All patients underwent surgi-     In 1948, for the first time, Rubin introduced the use of
    cal procedures and the therapeutic strategy was         alloplastic implants, whose practice, however, was
    determined based on the anomalies presented.            going to be limited to augmentative genioplasty cases
    Results. 113 patients had a II class dental skeletal    of minor entity (4). During the 1950s, there has been
IC




    occlusion, 180 patients had a III class dental-skele-   a significant improvement in implants and materials
    tal occlusion and 222 patients had skull-facial ab-     quality, that leds to the creation of implants extremely
    normalities. 5 patients underwent only a genioplas-     close to the natural anatomic shape.
    ty, 82 patients underwent a genioplasty associated      Genioplasty as a cosmetic procedure is performed
C




    with BSSO, 175 patients underwent a genioplasty         when skull and face malformations occur, causing an
    associated with Le Fort I osteotomy and the re-         alteration of size and chin abnormalities in all three
    maining 253 patients underwent a genioplasty as-        dimensions. Among this group of abnormal morbidi-
    sociated with BSSO and Le Fort I osteotomy.             ties, there are dental-skeleton malformations and
©




    Conclusion. The experience shows that genio-            mandibular asymmetries (5).
    plasty has been successfully introduced in or-          The type of abnormality that needs to be addressed
    thognathic surgical therapeutic procedures, for         determines the technique to be used and the type of
    dental-skeleton abnormalities and mandibular            displacement that needs to be performed. In fact,
    asymmetries treatment. In recent years, the evolu-      sliding genioplasty can both be performed, according
    tion of computer systems has allowed an accura-         to the nature of the case, through osteotomies or allo-
    te assessment and programming, by means of the          plastic implants.

    110                                                                     Annali di Stomatologia 2015; VI (3-4): 110-112
    Aesthetic restoration in maxillo-mandibular malformations: the role of genioplasty


    This study wants to describe the experience acquired            ple) underwent only a genioplasty, 82 patients (16%
    by the Authors concerning genioplasty planning, re-             of the sample) underwent a genioplasty associated
    sults and surgical methods.                                     with BSSO, 175 patients (34% of the sample) under-
                                                                    went a genioplasty associated with Le Fort I osteo-
                                                                    tomy and the remaining 253 patients (49% of the




                                                                                                            i
    Materials and methods                                           sample) underwent a genioplasty associated with BS-




                                                                                                          al
                                                                    SO and Le Fort I osteotomy.
    From January 2009 to December 2014, 515 genio-                  Only 50 patients of the study group have experienced
    plasties were performed, in association with orthog-            a postoperative complication. 4 patients (0,7% of the




                                                                                                       on
    nathic surgery at the Department of Odontostomatol-             sample) reported anesthesia of the lower lip, 10 pa-
    ogy and Maxillofacial Surgery, Policlinico Umberto I,           tients (2% of the sample) reported alloplastic implants
    “Sapienza” University of Rome, Italy.                           migration, followed by a second treatment for reposi-
    Among the most frequent pathologies addressed,                  tioning, 36 patients (7% of the sample) reported an




                                                                                              zi
    there were dental-skeleton malformations and                    infection, with abscess in the site of implant.
    mandibular asymmetries.
    Patients, 183 males and 338 females, were aged 23
                                                                    Discussion




                                                                                 na
    years average. The sample series was divided ac-
    cording to specific pathologies: 22% (113 patients)
    with II class dental skeletal occlusion, 35% (180 pa-           The experience acquired, confirmed by the International
    tients) with III class dental-skeletal occlusion and            Literature (7-10), shows that genioplasty has been suc-
    43% (222 patients) with skull-facial abnormalities.             cessfully introduced in orthognathic surgical therapeutic




                                                                      er
    All patients underwent surgical procedures after com-           procedures, for dental-skeleton abnormalities and
    pleting the following diagnostic tests: orthopanoramic X-       mandibular asymmetries treatment. There are a few
    rays, skull teleradiography in laterolateral and postero-       dental-skeleton abnormalities, such as II class ipo-di-
    anterior projection, statigraphy of articulations and, in re-   verging with tight mandibular angle, that usually require
    cent years, magnetic resonance imaging to visualize the

                                                             t      advancement, set back or drop genioplasty. II class hy-
    temporomandibular joint. Surgical procedures and
                                                          In        per-diverging with wide mandibular angle usually re-
    movement to perform was determinated according to               quires advancement or drop genioplasty. III class ipo-di-
    the abnormality that had to be addressed. Patients un-          verging with tight mandibular angle usually requires set
    derwent various types of surgery: 1% (5 patients) only          back and drop genioplasty. On the other side, III class
    genioplasty, 16% (82 patients) genioplasty associated           hyper-divergin with wide angle may need advancement,
                                               ni
    with BSSO, 34% (175 patients) genioplasty associated            set back or even rise genioplasty (10-13).
    with Le Fort I osteotomy, 49% (253 patients) genioplasty        For some mandibular asymmetries (both inborn or ac-
    associated with BSSO and Le Fort I osteotomy. While             quired), such as microsomia, anchilosis and others, sur-
                                    io


    preparing surgical intervention, either morpho-structural       gical treatment includes the restoration of chin propor-
    features of stomatognatic system and specific parame-           tions and often the return to vertical and transversal di-
    ters for chin evaluation have to be considered.                 ameters of the mandibular angle. Therefore, it is manda-
                          iz



    In our Department we exploit an integration of data             tory to achieve the complete restoration of the mandibu-
    obtain from a profile-metric exam and the Legan’s an-           lar profile. Superior repositioning and advancement of
    gle exam. Lega’s angle is an ideal angle created by             the chin and myocutaneous structures produce both
          Ed




    the line projected through the sub-nasal and the pro-           functional and aesthetic benefits for the patient (8).
    jected through the sub-nasal and the pogonion point,            While preparing surgical intervention, either morpho-
    and it helps in evaluating morpho-structural features           structural features of stomatognathic system and spe-
    on the sagittal plane (6). On the vertical plane we use         cific parameters for chin evaluation have to be con-
    a profile-metric exam implementing the thirds rule.             sidered. Surgical methods, in addition to entity and
                                                                    direction of surgical movements, will be determined
IC




                                                                    integrating data obtained from the above mentioned
    Results                                                         parameters. According to our experience, before
                                                                    1989, 65% of patients, after their first maxillo-
    Between January 2009 to December 2014, 515 pa-                  mandibular re-positioning surgery, needed extra com-
C




    tients with maxillo-mandibular malformations were               plementary cosmetic procedures. Nowadays, thanks
    submitted to an intervention of genioplasty.                    to the improvements made in the technology of se-
    Of the 515 patients, 113 patients (22% of the sample)           curing tools (RIF), and in surgical and anesthetic
    had a II class dental skeletal occlusion, 180 patients          techniques, it is now possible to perform at the same
    (35% of the sample) had a III class dental-skeletal             tie combined treatments.
©




    occlusion and 222 patients (43% of the sample) had              In most cases, dental-skeletal abnormalities can be as-
    skull-facial abnormalities. 183 patients were males             sessed during a single intervention (10). The planning of
    and 338 were females with a ratio M:F of 1:2, with an           surgical treatment for inborn mandibular asymmetries,
    average age of 23 year.                                         such as microsomia, is more complicated, due to soft-tis-
    The therapeutic strategy was determined based on                sues deficit involvement. In these cases, surgery must be
    the anomalies presented: 5 patients (1% of the sam-             performed, in our opinion, on a two-time approach basis.

    Annali di Stomatologia 2015; VI (3-4): 110-112                                                                        111
    F. Fabio et al.


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    112                                                                             Annali di Stomatologia 2015; VI (3-4): 110-112
