Captain America's Shield Genioplasty.

ABSTRACT: The chin represents one of the most important determinants of the facial aesthetics. Like many aesthetic parameters, the "ideal" chin has changed in history regarding projection and prominence. From the retrusive profiles of the Renaissance, stronger and more defined mandibular contour are nowadays desired both by masculine and feminine population.This change in the ideal references plays an important role in diagnosis and treatment planning. Various techniques for chin augmentation have been described, using both alloplastic materials and osteotomies.An interesting osteotomy variant, so-called chin shield osteotomy, has been described by Triaca et al to avoid a deep mentolabial fold. The authors describe herein the use of a shield plate, very similar in his form to Captain America's shield, that can at the same time provide bone fixation and soft tissues sustain in the mentolabial fold region, preventing the invasion of the gap between the bone fragments by the connective tissue, as it happens in a guided bone regeneration procedure.

The Pyramid Chin Augmentation: A New Technique.

ABSTRACT: The surgical approach to chin for esthetical purpose can be isolated or in a combination with other treatments like maxillomandibular surgery. Both possibilities include sliding genioplasty or implants of autologous or alloplastic materials. In this article, the authors present their new technique, the Pyramid Chin Augmentation.In January 2020, a 40-year-old male patient came to authors' observation asking for a great augmentation in the sagittal dimension of the chin, a better pronunciation of mandibular angles and of his cheekbones. The surgical treatment consisted in three different procedures at the same time: a chin wing osteotomy, a Pyramid Chin Augmentation and zygomatic PEEK custom-made malar implants. The pyramid was created on the body of the chin wing with a cortical bone graft from the oblique line of the ascending ramus of the mandible. The harvested bone was cut into strips of rectangular shape gradually shorter to be superimposed on the wing forming a pyramid. A fixation with 2 screws was performed and then was necessary to smoothen the edges of the bone layers.The result immediately after the end of the surgery was in line with the set goals. The mandibular angles were more prominent, the chin was more sagittal pronounced, and there was no evidence of depression in the symphysial region.The Pyramid Chin Augmentation Technique can be a valid tool in chin augmentation surgery and can also represent an effective procedure in the finishing touch of other facial surgery techniques.

Correlation between cranial base morphology and the position of the glenoid fossa in patients with facial asymmetry.

The purpose of this study was to relate the facial asymmetries with possible impairments of the skull base, particularly with regard to the three-dimensional position of the glenoid fossa. Fifty-eight subjects met the inclusion criteria (25 men and 33 women) and were included in the analysis. All patients underwent three-dimensional computed tomographies. Patients were classified into 3 asymmetry groups: vertical plane asymmetries, transversal plane asymmetries (TAs), and hybrid forms. A control group, composed of 29 subjects having obstructive sleep apnea syndrome with no asymmetries, was used to compare data from the study populations. The glenoid fossa moved forward and superiorly on the affected side if compared with the healthy side both in the vertical plane asymmetry group and in the TA groups (P < 0.001). Differences were wider in the TA group. Statistically significant differences regarding the middle and posterior cranial base angles were observed between the affected side of the TA patients and the control group. We reported an amplitude reduction of the middle cranial base angle and an increase of the posterior cranial base angle in the affected side. The glenoid fossa could represent the missing link between the development of the temporal region and the ipsilateral hemimandible.