Goals/Purpose: Orthognathic surgery and orthodontic treatment is ideal solution to correct prognathic and asymmetric lower face. However, because of the long treatment time and high cost, the patients without occlusal and functional problems want to avoid orthognathic surgery for correcting their prognathic and asymmetric face. The authors used complex genioplasty combined with mandibular contouring to correct prognathic and asymmetric lower face without malocclusion.
Methods/Technique: Total 120 patients with prognathic and asymmetric lower face underwent complex genioplasty combined with mandibular contouring. The patients had no occlusal and functional problem and some of them had previously received orthodontic treatment. The facial morphology and skeleton was evaluated by clinical photographs, cephalographs, and three-dimensional CT imaging. The approach to mandible was accomplished with conventional intra-oral vestibular incision and subperiosteal dissection. Complex genioplasty was mainly consisted of vertical reduction, horizontal reduction, and sliding genioplasty. The amount and area of reduction was determined depending on the pre-surgical analysis and assessment. The distal segments then were placed in the desired position, and fixed with plates and screws. After complex genioplasty, the bony edge lateral and proximal mandible were trimmed to desired amount using oscillating saw in order to obtain more natural curvature of the mandibular lower border. Resection of bony edge was extended to mandibular angle for contouring the whole mandible. The treatment outcomes were evaluated by comparison of preoperative and postoperative radiographs and photographs.
Fig. 1. Complex genioplasty: vertical reduction, horizontal reduction, and sliding genioplasty. (Left) Osteotomy. (Right) Fixation.
Results/Complications: The amount of the vertical reduction and the horizontal reduction ranged from 0 to 4mm and 0 to 10mm, respectively. Postoperatively, we achieved the balanced and delicate lower face. The protrusive and asymmetric chin was efficiently corrected. Complications included infection in 6 cases, hematoma in 5 cases, and numbness of the lip or lower incisor in 8 cases. All the complications resolved within 6 months with conservative treatments.
Fig. 2. A 34-year-old woman who desired a smooth lower face underwent a complex genioplasty combined with mandibular contouring. (Above, left) Preoperative lateral view. (Above, right) Postoperative lateral view. (Below, left) Preoperative lateral cephalograph. (Above, right) Postoperative lateral cephalograph.
Fig. 3. A 28-year-old woman with asymmetric lower face underwent a complex genioplasty combined with mandibular contouring. (Above, left) Preoperative lateral view. (Above, right) Postoperative lateral view. (Below, left) Preoperative cephalograph. (Above, right) Postoperative cephalograph.
Conclusion: Complex genioplasty combined with mandibular contouring is a good alternative for correcting prognathic and asymmetric lower face without malocclusion. Compared to orthognathic surgery, this method has several merits such as simple procedures, short recovery time, and low cost.