Plication of the Suprahyoid Muscles Concomitant with Genioplasty to Improve the Aesthetics of the Submandibular Region / Plicatura de los Músculos Suprahioideos Concomitante con Genioplastia para Mejorar la Estética de la Región Submandibular

In addition to functionally correcting skeletal facial deformities, orthognathic surgery also has a great impact on aesthetics and facial proportions. However, patients who have soft tissue changes, such as tissue flaccidity, may not achieve an ideal result, and require complementary surgical techniques that promote aesthetic refinement. The literature on less invasive techniques is limited, and therefore, this work aims to report a surgical technique performed concomitantly with genioplasty to refine the harmony of the submandibular region, in a simple and effective way. Patient with skeletal class II deformity, with lack of mandibular definition and submandibular flaccidity, underwent bimaxillary advancement orthognathic surgery with advancement genioplasty to correct chin retrusion. Due to limited results with bone repositioning alone, plication of the suprahyoid musculature was performed in association with the same approach used in the genioplasty. As a result, there was traction in the cervical region, with a consequent decrease in the submental-cervical angle and improvement in submandibular aesthetics. Furthermore, there was no need for extensive surgical intervention and no impairment of the functional results of the orthognathic surgery itself. Therefore, it can be concluded that plication of the suprahyoid musculat ure concomitantly with genioplasty is a technique that promotes aesthetic gains in the cervical region.

Además de corregir funcionalmente las deformidades faciales esqueléticas, la cirugía ortognática también tiene un gran impacto en la estética y las proporciones faciales. Sin embargo, los pacientes que tienen cambios en los tejidos blandos, como la flacidez, pueden no lograr un resultado ideal y requieren técnicas quirúrgicas complementarias que promuevan el refinamiento estético. La literatura sobre técnicas menos invasivas es limitada, por lo que este trabajo tiene como objetivo reportar una técnica quirúrgica realizada concomitantemente con la genioplastia para refinar la armonía de la región submandibular, de manera simple y efectiva. Se trató a un paciente con deformidad esquelética clase II, con falta de definición mandibular y flacidez submandibular, intervenida de cirugía ortognática de avance bimaxilar con genioplastia de avance para corregir la retrusión del mentón. Debido a los resultados limitados solo con el reposicionamiento óseo, se realizó la plicatura de la musculatura suprahioidea en asociación con el mismo abordaje utilizado en la genioplastia. Como resultado, hubo tracción en la región cervical, con la consiguiente disminución del ángulo submentoniano-cervical y mejoría en la estética submandibular. Además, no hubo necesidad de una intervención quirúrgica extensa ni deterioro de los resultados funcionales de la cirugía ortognática en sí. Por lo tanto, se puede concluir que la plicatura de la musculatura suprahioidea concomitantemente con la genioplastia es una técnica que promueve ganancias estéticas en la región cervical.

About chin (genioplasty) surgery / Sobre cirugía del mentón (genioplastía)

Facial harmony is the consequence of a proper balance between all facial structures. The identification and classification of morphologic characteristics that detract from facial harmony is most effectively accomplished by clinical examination. The maintenance of the ratios between the facial thirds, correct spatial bone position and soft tissues accommodation are all factors that directly contribute in a balanced facial profile. The chin, likewise, contributes significantly in facial balance, mainly in the profile view. Expressive changes on chin position are associated with the perception of strong or delicate characters. Thus, over the years, a series of studies has been constructed focusing on mandibular osteotomies techniques that enable changes in chin position: advances, setback, extrusion, intrusion, widening, narrowing and asymmetry. This study aims to address historical and technical aspects of genioplasty; associating patient's condition with the surgical techniques that can be applied for correction of chin deformities.

La armonía facial es la consecuencia del balance entre las estructuras facial. La identificación y clasificación de las características morfológicas que están acompañando la armonía facial son mas efectivas al realizar un estudio de análisis facial. La obtención de promedios entre los tercios, corrección especial de la posición del hueso y la acomodación de los tejidos blandos son factores directamente involucrados en el balance del perfil. El mentón, contribuye significativamente en este balance. Cambios expresivos en la posición del mentón son asociados con la percepción de características fuertes o delicadas. Durante los años, una serie de estudios han sido desarrollados enfocándose en las osteotomías mandibulares y técnicas capaces de alcanzar los cambios en la posición del mentón: avances, retrocesos, extrusiones, ensanchamientos, estrechamientos y asimetrías. Este estudio pretende orientar las condiciones históricas y técnicas respecto de la genioplastia; la asociación de las características del paciente con la técnica quirúrgica pueden ser aplicadas para la corrección de las deformidades.

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.

Clinical evaluation for chin augmentation: literature review and algorithm proposal / Avaliação clínica para avanço de mento: revisão da literatura e proposta de um algoritmo

ABSTRACT INTRODUCTION: The esthetic balance of the face results from harmonic and symmetrical facial proportions. The literature describes several methods for lower-third facial analysis, but lacks a simple and practical method. OBJECTIVE: To review the methods of analysis of the ideal projections of the chin based on soft tissues, showing the advantages and disadvantages of each. METHODS: Literature review through the PubMed database. RESULTS: The following methods for chin analysis based on soft tissues were reviewed: Gonzalles-Ulloa, Goode, Merrifield, Silver, Legan, Gibson & Calhoun, cervicomentual angle, and mentocervical angle. CONCLUSION: An adequate analysis of the proportions of the face and facial disharmony is essential for the correct indication of the necessary procedures and good surgical outcome. The authors propose an algorithm to facilitate the indication for chin augmentation surgery.

Resumo Introdução: O equilíbrio estético da face resulta de proporções faciais harmônicas e simétricas. A literatura descreve vários métodos de análise do terço inferior da face, mas carece de um método simples e prático. Objetivo: Revisar os métodos de análise da projeção ideal do mento baseadas em tecidos moles, mostrando as vantagens e desvantagens de cada um. Método: Revisão da literatura através da base de dados Pubmed. Resultados: Os seguintes métodos para análise do mento baseada em partes moles são revisados: Gonzalles-Ulloa, Goode, Merrifield, Silver, Legan, Gibson & Calhoun, ângulo cervicomentual e ângulo mentocervical. Conclusão: A análise adequada das proporções da face e desarmonia facial faz-se essencial para a correta indicação dos procedimentos necessários e bom resultado cirúrgico. Propomos um algoritmo para facilitar indicação de avanço de mento.

Manejo quirúrgico combinado de prominencia del ángulo mandibular y microgenia / Combined surgical management of mandibular angle prominence and microgenia

El mentón juega un papel muy importante en la estética facial. Diferentes deformidades tanto de volumen como de posición pueden presentarse a este nivel, y es la microgenia una de las más frecuentes. Las opciones de tratamiento incluyen el uso de siliconas, materiales aloplásticos e injerto óseo autólogo. Los autores reportan el uso del hueso extraído del ángulo mandibular para el aumento del mentón. Se presenta el caso de una paciente femenina de 18 años de edad, de raza blanca, la cual fue atendida por el Grupo multidisciplinario de cirugía ortognática del Hospital V I Lenin, debido a la preocupación por el ancho de su cara. El examen físico y los exámenes complementarios correspondientes diagnosticaron una prominencia bilateral del ángulo mandibular asociada con una microgenia. Se decidió realizar cirugía remodeladora de ambos ángulos mandibulares y genioplastia de aumento de altura y discreto avance, con utilización del hueso extraído del gonion. Se lograron resultados estéticos satisfactorios sin evidencia de reabsorción ósea. Se concluyó que la utilización del injerto óseo autólogo del ángulo mandibular constituye una alternativa de tratamiento eficaz para la corrección de la microgenia(AU)

Chin play a very important role in facial aesthetics. Different deformities of volume and of position may occur at this level and it is the microgenia one of the more frequent. Treatment options include the use of silicone, alloplasty materials and autologous bone graft. Authors report the use of the bone removed from mandibular angle to increase the chin. This is the case of a white female patient aged 18 seen by the Orthognathics Multidisciplinary Staff of V I Lenin Hospital due to its uncommon face width. The corresponding physical examination as well as the complementary ones diagnosed a bilateral prominence of mandibular angle associated with a microgenia. Surgery carried out was of remodeling type of both mandibular angles and genioplasty.of height increase and a discrete advancement using the bone removed from the gonion. There were satisfactory aesthetic results without evidence of bone reabsorption. We conclude that use of autologous graft of mandibular angle is an effective treatment alternative for correction of microgenia(AU)