Split-Overlapping Genioplasty: Surgical Technique, Morphological and Radiological Long-Term Outcomes.

BACKGROUND: The overlapping bone flap genioplasty, described by Tessier, was developed to treat major retrognathia or long and retruded chins. For 15 years, we have used a modified version of this technique to avoid its drawbacks. The aim of this article is to describe our modification and evaluate the long-term morphologic and radiologic outcomes. PATIENTS AND METHOD: The authors included every split-overlapping genioplasty performed in our department between 2004 and 2014. Demographics, surgical data, and complications were recorded. Radiologic bone resorption was evaluated comparing preoperative, day-1 postoperative, and year-1 postoperative cephalometric x-rays. Morphologic outcomes were evaluated on standardized pre- and postoperative views using an analogic Likert scale. SURGICAL TECHNIQUE: The main modification of the procedure consists in separating the posterior cortex of the transplant using a reciprocating saw. After overlapping the reduced transplant onto the mandible, the posterior cortex is used as an apposition graft to soften the labiomental crease. RESULTS: Forty-seven patients were analyzed during this period. In 44 patients, the procedure was combined with mandibular and/or maxillary osteotomy. The average reduction of symphysis height was 5 mm, and the average pogonion advancement was 4.3 mm. After 1 year, we recorded 7% average bone resorption. No major complications (nerve injury, hematoma, among others) were reported. Morphologic outcomes were deemed satisfactory or very satisfactory in the vast majority of cases. CONCLUSION: Split-overlapping genioplasty is a safe and reliable procedure with stable, long-lasting outcomes. This versatile technique is particularly useful for the correction of a massive symphysis or high and retruded chins.

Evaluation of a Radiological Score in the Management of Pure Fractures of the Orbital Floor.

PURPOSE: The authors had for aim to further assess the predictive power and the relevance of a previously published radiological decision taking score for pure fractures with recording of clinical data. METHODS: The authors retrospectively included all patients managed in the authors' department for a pure orbital floor fracture, from June 2012 to November 2013. The authors collected clinical data including diplopia and enophtalmos, at initial status and after 3-months of follow-up. The radiological data was also recorded: rate of the fractured orbital floor, maximal height of periorbital tissue herniation, and a 4-grade muscular sub score. The treatment determinants were assessed by univariate analysis, with χ tests or Fisher exact tests for qualitative variables, and Student t tests for quantitative ones. A multivariate analysis was then performed with a stepwise logistic regression. RESULTS: The authors included 90 patients. The authors proposed a simple score (with a specificity of 79% and a sensitivity of 56%) for the indication to operate, using the rate, which was a significant predictor of treatment in the multivariate analysis. CONCLUSIONS: The authors' study is another step in the standardization of treatment decision for pure orbital floor fractures. The proposed score requires further clinical research to be validated but already helps to compare series of patients.