Changes in the airway after mentoplasty (genioplasty): systematic review / Cambios en la vía aérea después de una mentoplastia (genioplastia): una revisión sistemática

SUMMARY: The aim of this research was to evaluate the changes obtained with the mentoplasty technique in the increase of the airway imaging. A systemic review was performed using the parameters of the prism matrix, in the PubMed, Science Direct, Redalyc database, covering the years 1984 to 2019 with the use of defined inclusion criteria. The authors independently applied the selected parameter of data extraction, study selection and risk-to-bias assessment. A total of 1,251 articles were obtained among the 3 databases, of which 10 met the inclusion criteria. The variables studied were: type of research, sample size, sex, age, dento-skeletal diagnosis, airway classification, diagnosis of obstructive sleep apnea syndrome (OSAS), type of imaging evaluation, variables evaluated in the image, pre and post-operative values, surgical technique and type of fixation used, other surgical procedures applied, and complications. In the cases of linear evaluation with cephalometric analysis (9 articles) they used PAS (posterior airspace), MP-H (mandibular plane to the hyoid) and SNB (saddle-nasion-point B), and SCSA (section area as the most relevant points, smallest cross section) and VT (total volume) in the volumetric evaluations (2 articles). The average change in posterior airspace achieved by the cited authors is 4.2 mm with standard deviation of 1.4 mm with the use of advancement mentoplasty. The most widely used technique was mentoplasty with a horizontal osteotomy by 5 authors. Based on the research there is a positive relationship between the increase in the airway and the advancement mentoplasty procedure, however, more standardized studies associated with the way of measuring and evaluating the relationship between advancement and the airway are necessary.

RESUMEN: El objetivo de esta investigación fue evaluar los cambios obtenidos con la técnica de mentoplastia en el incremento de la via aérea. Una revisión sistemática fue realizada utilizando parámetros de la matriz prisma, en PubMed, Science Direct, Redalyc database, cubriendo los años 1984 a 2019 con criterios de inclusión definidos. Los autores aplicaron de forma independiente los parámetros de selección y extracción de datos, selección de estudios y riesgos de sesgo. Un total de 1251 artículos fueron obtenidos de las 3 bases de dato, donde 10 artículos cumplieron los criterios de inclusión. Las variables estudiadas fueron: tipo de investigación, tamaño de la muestra, genero, edad, diagnóstico dento esqueletal, clasificación de la vía aérea, diagnostico de síndrome de apnea del sueño (SAOS), tipo de evaluación de la imagen, variables evaluadas en la imagen en pre y postoperatorio, técnica quirúrgica y tipo de fijación utilizada, otros procedimientos quirúrgicos y complicaciones. En el caso de la evaluación linear con cefalometria (9 artículos), usaron PAS (posterior airspace), MP-H (plano mandibular hacia el hueso hioide) y SNB (silla turca-nasion- punto B) y SCSA (sección de puntos mas relevantes, menores transfversales) y el VT (volumen total) en las evaluaciones volumétricas (2 artículos). El promedio de cambio posterior de la vía aérea citado por autores fue de 4,2 mm con una desviación estándar de 1,4 mm con el uso de la mentoplastia de avance. La técnica mas habitual fue la mentoplastia con osteotomía horizontal (5 autores). Basados en esta investigación existe una relación positiva entre el incremento de la vía aérea y el avance con genioplastia; sin embargo, mas estudios estandarizados junto con medidas definidas y la evaluación correcta del avance y la vía área son necesarios.

Aumento mentoniano com retalho cervical associado à ritidoplastia / Chin augmentation with cervical flaps associated with rhytidoplasty

Introdução: A falta da projeção mentoniana no terço inferior da face algumas vezes é responsável pela quebra da harmonia do contorno facial. A utilização de implantes aloplásticos, preenchimentos submetidos à ritidoplastia para correção destas deformidades. Neste estudo, propomos uma nova manobra para aumento da projeção mentoniana com uso de um retalho cervical associado à ritidoplastia. Métodos: Foram avaliados 11 pacientes operados no período de 01/2017 a 01/2018, utilizando-se o retalho cervical para projeção mentoniana, e tendo como critério de inclusão somente pacientes que almejavam um aumento mentoniano, sem utilização de próteses, preenchimentos ou abordagem óssea, e que seriam submetidos à ritidoplastia. Resultados: Através da análise cefalométrica evidenciou-se melhora da projeção mentoniana e do contorno cervical, e não houve complicações no pós-operatório imediato ou tardio. Conclusão: O retalho cervical utilizado para aumento mentoniano além de apresentar resultados e aceitação satisfatórios, elimina o uso de materiais sintéticos, redução de custos, segurança e durabilidade, alcançando um contorno mandibular mais refinado e uma projeção mentoniana mais natural.

Introduction: The lack of chin projection in the lower third of the face is sometimes responsible for the breaking of the facial contour harmony. Alloplastic implants, fillers, and osseous advancements have been used to correct these deformities. In this study, we propose a new maneuver to increase chin projection by using a cervical flap associated with rhytidoplasty. Methods: We assessed 11 patients who underwent operations using the cervical flap for chin projection between January 2017 and January 2018. The inclusion criteria were only patients who desired chin augmentation without the use of prosthetics, fillers, or osseous approaches, and those who would undergo rhytidoplasty. Results: A cephalometric analysis revealed improvements in chin projection and cervical contour, and no complications in the immediate or late postoperative period. Conclusion: In addition to presenting satisfactory results and acceptance, the cervical flap used for chin augmentation eliminated the use of synthetic materials, reduced surgical costs, and improved safety and durability, achieving a more refined mandibular contour and natural chin projection.

Effect of mentoplasty on esthetic perception of dental surgeons, dental students and lay persons / Efeito da mentoplastia na percepção estética de cirurgiões-dentistas, estudantes de odontologia e leigos

Objective: was to evaluate the influence of mentoplasty on esthetic perception of dental surgeons, dental students and lay persons. In addition, to determine whether the outstanding chin affects the perceived desire for orthognathic surgery. Material and Methods: An image of an ideal silhouette was created. This image was manipulated to create another six images with different degrees of retrogenia and progenia in increments, advancing and receding the chin on a scale of 5 mm (from +15 to -15 mm) in the anteroposterior and vertical directions. Once the images were obtained, a questionnaire was created, which was evaluated by lay persons, dental surgeons and dental students (n = 50). The evaluators used a visual analog scale to analyze the images, establishing a score ranging from 0 to 10. Associated with the scale, the evaluators were asked whether they wished to have some surgical correction performed if the image in question were a representation of their own facial profile. Results: demonstrated that image H (0 mm) was ranked as the most attractive by the dental surgeons, while the dental students and lay persons scored B (-5 mm) as the best image. In general, images A (+15 mm) and D (-15 mm) were those that most induced a desire for corrective surgery. Conclusion: the prognathic and retrognathic facial profiles were unpleasant and perceptible to the dentist, dental student and lay person. The more projected and retracted the chin was, the greater was the desire to have orthognathic surgery performed. (AU)

Objetivo: avaliar a influência da mentoplastia na percepção estética de cirurgiões-dentistas, estudantes de Odontologia e leigos. Além de determinar se o destaque do mento afeta o desejo percebido ORIGINAL ARTICLE Effect of mentoplasty on esthetic perception of dental surgeons, dental students and lay persons Efeito da mentoplastia na percepção estética de cirurgiões-dentistas, estudantes de odontologia e leigos Matheus Melo PITHON1 , Diego Oliveira GUEDES1 , Solane Domingues LEAL1 ,Maria Luiza Anselmo da SILVA1 , Raphaela Rodrigues DANTAS1 , Ketlly Cruz da Cunha PELEGRINI1 , Raildo da Silva COQUEIRO2 1 - Southwest Bahia State University ( UESB) - Vitória da Conquista ­ BA - Brazil. 2 - Federal University of Santa Catarina (UFSC) - Florianópolis ­ SC - Brazil. doi: 10.14295/bds.2019.v22i2.1687 UNIVERSIDADE ESTADUAL PAULISTA "JÚLIO DE MESQUITA FILHO" Instituto de Ciência e Tecnologia Campus de São José dos Campos Ciência Odontológica Brasileira por cirurgia ortognática. Material e Métodos: a imagem de uma silhueta ideal foi manipulada para criar outras seis imagens com diferentes graus de retrogenia e progenia em incrementos, avançando e recuando o mento numa escala de 5 mm (de +15 a -15 mm) nos sentidos ântero-posterior e vertical. De posse dessas imagens criou-se um questionario que foi avaliado por leigos, Cirurgiões-Dentistas e estudantes de Odontologia (n = 50). Os avaliados utilizaram uma escala visual analógica para analisar as imagens, estabelecendo nota que variam de 0 a 10. Associado a escala os avaliadores foram questionados se eles teriam vontade de realizar alguma correção cirúrgica caso aquela imagem representasse o seu próprio perfil facial. Resultados: demostraram que a imagem H (0 mm) foi ranqueada como a mais atratativa pelos cirurgiões dentistas, enquanto os estudantes de odontologia e pessoas leigas pontuaram a B (-5 mm) como a melhor. De forma geral, as imagens A (+15 mm) e D (-15 mm) foram as que mais induziram o desejo por cirurgia corretiva. Conclusão: o perfil facial prognata e retrognata é desagradável e perceptível para o dentista, o estudante de odontologia e o leigo. Quanto mais projetado e retruido for o mento maior o desejo pela realização de cirurgia ortognática. (AU)

Reabsorção óssea associada ao implante de silicone em mentoplastia: relato de caso clínico / Bone reabsorption associated with silicone implants in mentoplasty: a clinical case report

Durante muitos anos, os implantes de silicone foram utilizados em cirurgias reconstrutivas e estéticas, principalmente em casos em que o perfil facial do paciente apresenta deficiência no terço inferior da face. Este material tem provado ser bem sucedido na maioria dos aspectos, contudo, algumas complicações já foram bem relatadas na literatura, como é o caso das reabsorções ósseas na região de mento mandibular. No presente artigo os autores apresentam dois casos clínicos de reabsorção óssea da cortical anterior do mento, associada ao implante de silicone e discutem a etiologia, as complicações e o plano de tratamento.

For many years, silicone implants were used in reconstructive and esthetic surgeries, especially in cases in which the facial profile of patients presented deficiencies in the inferior third of the face. This material proved to be successful in most aspects. However, several complications were well reported in the literature, as the case of bone reabsorption in the region of the mandibular chin. In this article, the authors present two clinical cases of bone reabsorption from the anterior cortex of the chin associated with silicone implants and discuss the etiology, complications, and treatment plan.

Combined Approach for Rejuvenation of the Lower Third of the Face and the Neck in the Male Patient

Most men develop deep crease in the nasolabial area and visible redundant tissue in the anterior neck with aging. The ideal operation for those patients seeking facial rejuvenation because of prominent nasolabial folds and neck soft-tissue laxity is the cervicofacial rhytidectomy. If the patient doesn't wish to have a conventional face/neck lift under general anesthesia, a combined approach based on summation of partially effective modalities is a good option. We present our experience with combined subcutaneous neck lift, platysmaplasty, mentoplasty, and platysma graft in the treatment of the lower third of the face and the neck, and obtained good results without complications using this comprehensive approach. In terms of morbidity, the procedure left inconspicuous scars. The platysma grafts remained in place and were not palpable and/or perceptible after insertion. Finally, postoperative recovery occurred uneventfully and no patients presented complications or the need for complementary treatment modalities. The incorporation of this innovative technique will provide us with more choices for addressing this controversial issue with a combined approach. The combination of proven methods may have better results than each one alone. It is a simple, safe, and inexpensive procedure that leaves no visible scars and has long-term adequate outcome. In conclusion, the presented procedure offers an additional technique of rejuvenating the lower third of the face and the neck with excellent results in the male patients.

Horizontal osteotomy combined with augmentation mentoplasty for serious chin microsomia / 中华医学美学美容杂志

Objective To introduce an effective surgical technique for repairing the serious chin microsmia and for resconstructing the outline of the chin. Methods After horizontal osteotomy the chin moved up and fixed with intraoral incision, implant was used in augmentation mentoplasty in order to increase heights and outshoot of the chin. Results In 9 patients suffering from chin microsomia all appearance of the chin had obvious improvement. Beautiful chin outline was reconstructed in esthetical standard. Post operative follow-up for 6 months to 2 years showed that all the patients were satisfied with the results. Conclusions Horizontal osteotomy combined with augmentation mentoplasty can obviously improve appearance of the chin. Lower lineament is reconstructed in esthetical standard.

A Study on mandibular retrognathism treated by implantation of prosthesis under the periosteum via oral incision / 中国微创外科杂志

Ojective To evaluate the effect of implatation of prosthesis under the periosteum via oral incision on mentoplasty. Methods The buccal morphology and structure of cadaver was studied with topographic methods. 43 cases of mentoplasty was treated by implatation of prosthesis under the periosteum via oral incision. Results The mandibular shape of all cases treated by mentoplasty were improved with successful and satisfactory effects. No complication occurred. Conclusions It suggested that the implatation of prosthesis under the periosteum via oral incision was a safe, effective procedure for mentoplasty.