Preoperative Radiology and Virtual Surgical Planning.

Virtual surgical planning enables precise surgical planning and translation of this planning into the operating room. Preoperative maxillofacial computed tomography scans are compared to a reference skull to identify desired surgical changes. In facial feminization surgery, these include forehead recontouring/frontal table setback, gonial angle reduction, and possible chin repositioning/reshaping, while in facial masculinization surgery, this includes forehead augmentation and gonial angle/chin augmentation. Cutting and recontouring guides as well as custom implants are then custom manufactured. Common guides include osteotomy guides, depth drilling guides, ostectomy guides, and guides for one/two-piece genioplasty or chin burring. Common implants include mandibular and chin implants.

Validation of a fully automatic three-dimensional assessment of orthognathic surgery.

The aim of the present study was to propose and validate FAST3D: a fully automatic three-dimensional (3D) assessment of the surgical accuracy and the long-term skeletal stability of orthognathic surgery. To validate FAST3D, the agreement between FAST3D and a validated state-of-the-art semi-automatic method was calculated by intra-class correlation coefficients (ICC) at a 95 % confidence interval. A one-sided hypothesis test was performed to evaluate whether the absolute discrepancy between the measurements produced by the two methods was statistically significantly below a clinically relevant error margin of 0.5 mm. Ten subjects (six male, four female; mean age 24.4 years), class II and III, who underwent a combined three-piece Le Fort I osteotomy, bilateral sagittal split osteotomy and genioplasty, were included in the validation study. The agreement between the two methods was excellent for all measurements, ICC range (0.85-1.00), and fair for the rotational stability of the chin, ICC = 0.54. The absolute discrepancy for all measurements was statistically significantly lower than the clinical relevant error margin (p < 0.008). Within the limitations of the present validation study, FAST3D demonstrated to be reliable and may be adopted whenever appropriate in order to reduce the work load of the medical staff.

Esthetic Surgery of the Chin in Cis- and Transgender Patients-Application of T-Genioplasty vs. Single-Piece Segment Lateralization.

Background and Objectives: Correction of lower face asymmetry still remains challenging in maxillofacial surgery. This report describes techniques for the lateral transposition of the symphyseal segment to restore lower face symmetry while maintaining gender-related features in cis- and transgender patients. Materials and Methods: A retrospective review of medical records of 31 patients who attended for esthetic corrective surgery after orthodontic camouflage or orthognathic treatment, or during facial feminization of the lower face between June 2021 and June 2023 was performed. Result: All patients underwent lateralization genioplasty (with or without advancement or setback), either with or without narrowing T-osteotomy supplemented with necessary procedures in order to obtain proper facial balance and desired esthetical effects, such as bichectomy, liposuction, and face and neck lift. The mean asymmetry of the chin was 5.15 mm and was surgically corrected either by single segment lateralization or T-shape narrowing genioplasty depending on the gender and esthetical requirements. No complications were reported. Conclusions: Lateral shift genioplasty serves as a powerful tool in primary and secondary corrective surgery for lower face asymmetry that maintains gender-specific facial features. It may serve either as an additive to orthodontic camouflage or a way to correct previous orthognathic surgery pitfalls. The surgeon performing esthetic genioplasty associated with gender-specific expectations must be trained in facelift and facial liposculpting techniques in order to provide the best results and properly choose the right procedures for the right patients.

Single-Step Full-Face Surgical Treatment of the Facial Profile.

The present study was performed to describe how much affordable, feasible, and straightforward is the approach the authors called "single-stage full-face surgical profileplasty," tailored to greatly improve the surgery of the facial profiling setting and achieve complete profile correction at the same time. From January 2010 to May 2019, 113 patients (95 females and 18 males; aged 19 - 63 years) were surgically treated for full-face profile amelioration. Profile correction was performed by using a combination of five procedures out of other various previously experienced: forehead fat grafting, rhinoplasty, lip fat grafting, genioplasty, and submental liposuction. All patients were assessed at 1, 3, 6, and 12 months following surgery for assessing the surgical profile treatment (SPT) outcome and any possible side effects of the combined treatment. Facial profile stability at 1 year was taken as the completion point of this treatment. Arnett et al's "Soft Tissue Cephalometric Analysis" (1999) was used to clinically evaluate the soft tissues before and after the SPT. Patients' satisfaction was measured with the Client Satisfaction Questionnaire-8" at 3 and 12 months after surgery. Statistics were used for Arnett et al's evaluation. Almost all the values were consistent and reached the normal ranges indicated by Arnett et al (p < 0.001), confirming that the desired results of the surgical profileplasty have been achieved. Single-stage full-face surgical profile treatment helps in correcting faults of the global facial deformity, in every single treated area, providing an overall improvement in facial aesthetics and harmony. Obtaining the simultaneous correction in the whole face has also the advantage of avoiding multiple surgical procedures, reducing postoperative discomfort, and the overall risks for the patient due to multiple surgical and anesthetic procedures.

Osseous genioplasty versus chin implants: early complications and patient satisfaction.

Osseous genioplasty and chin augmentation with implants are the two main treatment options for retrognathia. This retrospective cohort study was performed to compare the prevalence of complications and patient satisfaction following osseous genioplasty and chin augmentation by implant. Eighty patients were included: 38 underwent advancement osseous genioplasty and 42 received chin implants (alloplastic, either Medpor or Silastic) intraorally or extraorally. The patients were assessed for complications 12 months after surgery, including neurosensory disturbances, infection or extrusion, wound dehiscence, and the need for reoperation. Patient satisfaction was evaluated using a visual analogue scale. The infection rate was significantly higher in the chin implant group than in the genioplasty group (P = 0.028). Moreover, dehiscence and the need for reoperation appeared to be more common following chin augmentation with implants. However, there was no significant difference in the prevalence of neurosensory disturbances between the two groups (P = 0.137). In the chin implants group, the extraoral approach resulted in a lower dehiscence rate than the intraoral approach. Patients in the genioplasty group had significantly higher satisfaction scores than those in the chin implant group (P = 0.001). Overall, the rates of the complications assessed were lower and patient satisfaction was higher after osseous genioplasty when compared to chin augmentation with implants.

Soft-Tissue Response following Genioplasty Combined with Anterior Segmental Osteotomy.

BACKGROUND: The authors' main aim was to analyze soft-tissue response of the chin following genioplasty with anterior segmental osteotomy, which enables optimal surgical planning of genioplasty. METHODS: Sixty-two patients who underwent genioplasty with concomitant anterior segmental osteotomy were divided into three groups depending on the direction of pogonion (Pog) movement: G1 (without sagittal change), G2 (advancement genioplasty), and G3 (setback genioplasty). All genioplasties included height reduction. Hard- and soft-tissue measurements with cephalometry were performed at T1 (before surgery), T2 (after surgery), and T3 (after orthodontic treatment) for the analysis of sagittal and vertical changes. Correlation and regression analyses were conducted to analyze soft- to hard -tissue movement and soft-tissue thickness changes. RESULTS: During the T1 to T2 period, the horizontal soft- to hard-tissue ratio at Pog was 0.85 in G2 and 0.80 in G3, and the vertical ratio at menton (Me) was 0.9 for all groups. The correlation coefficients were 0.64 (G2) and 0.83 (G3) at Pog and 0.9 (all), 0.85 (G1), 0.95 (G3) at Me. There was no significant correlation between initial soft-tissue thickness and soft-tissue response ratio. During the T2 to T3 period, no significant relapses were observed, which demonstrates the stability of anterior segmental osteotomy combined genioplasty. CONCLUSIONS: Clinically and statistically significant soft-tissue responses were demonstrated at Pog and Me. The higher values in G3 in particular suggest that setback genioplasty with anterior segmental osteotomy is an effective treatment alternative to conventional two-jaw surgery in some patients with bimaxillary prognathism with macrogenia. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Does Aesthetic Osseous Genioplasty Impact Upper Airway Volume?

BACKGROUND: Although maxillomandibular advancement is the treatment of choice for obstructive sleep apnea syndrome (OSAS) in the presence of underlying maxillomandibular complex hypoplasia, there is still a gap in the literature regarding the impact of genioplasty upon upper airway volume (UAV). OBJECTIVES: The aim of this study was to evaluate the impact of isolated osseous genioplasty upon UAV. METHODS: A retrospective analysis of all patients subjected to isolated osseous genioplasty between July 2015 and July 2022 was conducted. Cone-beam computed tomography was performed preoperatively and postoperatively to assess the chin and hyoid 3-dimensional (3D) spatial position and UAV changes after surgery. RESULTS: A total of 44 patients were included in the study. Regarding surgical movements of the chin, almost all patients received a sagittal movement (n = 42; 39 forward and 3 backward), while in 8 patients a vertical movement (5 upward and 3 downward) was applied, and in 6 patients the chin was centered. Statistically significant increases in total UAV (P = .014) and at the level of the oropharynx (P = .004) were observed. Specifically, chin centering, upward and forward movements enlarged the oropharynx volume (P = .006, .043 and .065, respectively). Chin advancement enlarged the hypopharynx volume (P = .032), as did upward movement of the hyoid bone (P < .001). CONCLUSIONS: Results of the study suggest that aesthetic osseous genioplasty impacts the UAV: each 3D spatial chin movement differently impacts the upper airway by enlarging or narrowing it. However, further studies addressing the apnea-hypopnea index are required to assess its effectiveness in treating OSAS.

[Three-dimensional comparative study on the stability of bimaxillary simultaneous genioplasty and simple genioplasty].

PURPOSE: To establish a three-dimensional method to evaluate whether there is a difference in stability between bimaxillary simultaneous genioplasty and simple genioplasty. METHODS: This study was a retrospective study. Sixty patients who underwent genioplasty were selected. They were divided into bimaxillary simultaneous genioplasty group (n=30) and simple genioplasty group (n=30). The spiral CT data of patients at 2 months before operation (T0), 7 days after operation (T1) and 12 months after operation (T2) were collected, reconstructed and separated, and the three-dimensional model of maxilla and mandible was obtained. A three-dimensional analysis method of stability was established by 3D-matching. Recurrences in three-dimensional space 12 months after surgery were analyzed in two groups of patients. Statistical analysis of the data was performed with SPSS 26.0 software package. RESULTS: In simple genioplasty, the maximum amount of the chin recurrence was sagittal backward recurrence (0.54±0.38) mm, and the sagittal recurrence rate was 12.27%. In bimaxillary simultaneous genioplasty, the maximum amount of the chin recurrence was sagittal backward recurrence (0.60±0.31) mm, and the sagittal recurrence rate was 12.96%. Rotation occurred in both groups 12 months after operation, which was 1.98±2.70° in the simple genioplasty group and 1.01±1.61° in the bimaxillary simultaneous genioplasty group(P＜0.05). There was no significant difference in the sagittal movement of the chin between the two groups, and in the sagittal recurrence(P＞0.05). CONCLUSIONS: The three-dimensional method established in this study can be used to evaluate the stability after genioplasty. The recurrence after genioplasty mainly occurred in the sagittal direction. The rotation trend of chin after genioplasty is worthy of attention. There was no increased risk for bimaxillary simultaneous genioplasty.

[Surgical treatment of a patient with mandibular micrognathia accompanied by obstructive sleep apnea syndrome using extended genioplasty]. / Khirurgicheskoe lechenie patsienta s mikrognatiei nizhnei chelyusti i sindromom obstruktivnogo apnoe vo sne metodom rasshirennoi genioplastiki.

A method for diagnosing, planning and surgical treatment of patients with micrognathia of the mandible with physiological occlusion is proposed, which makes it possible to objectively assess the severity of the anomaly and concomitant functional disorders of external respiration in the nasopharynx and oropharynx, as well as to identify the pathophysiological mechanisms of obstructive sleep apnea syndrome (OSAS) and develop an optimal surgical treatment plan with high functional and aesthetic results.

Factors affecting progressive facial swelling immediately after orthognathic surgery: A retrospective cohort study.

The aim of this study was to identify clinical factors associated with progressive facial swelling after orthognathic surgery. Patients diagnosed with jaw deformities and undergoing orthognathic surgery were retrospectively evaluated, and those with surgical site infection, Le Fort I osteotomy, or genioplasty only were excluded. Facial swelling volume was calculated by comparing facial volume preoperatively and three days postoperatively using 3D images and image analysis software (VECTRA H2). FXIII was measured within three days after surgery in only patients with unexplained postoperative bleeding or hematoma. The correlation between facial swelling volume and clinical factors was statistically analyzed. Facial swelling volume was examined in 78 patients. Univariate analysis showed a significant difference between facial swelling volume (mean = 41.6 cm3) and operation time (mean = 209.3 min, r = 0.283, p = 0.012), ΔHb level (mean = 1.18 g/dL, r = 0.235, p = 0.039), as well as decreased factor XIII activity (mean = 75.3%, p = 0.012). Multivariate analysis showed a significant difference between facial swelling volume and FXIII deficiency (standard error = 6.44, p = 0.031).Progressive facial swelling immediately after orthognathic surgery may be due to factor XIII deficiency.

Stability of box genioplasty: a retrospective study.

In box genioplasty it is possible to advance, retrude, impact, and elongate, as well as to correct asymmetry. The aim of this study was to analyse the stability of box genioplasty as part of orthognathic correction. Twenty-five consecutive patients who had gone through the multidisciplinary pathway were selected. Menton and pogonion positions on radiographs taken just prior to surgery, and actual surgical movement on three-week and 12-month postoperative cephalograms, were compared. A one-sample Wilcoxon test was applied to assess whether the distributional change in advancement and vertical measurements was equal to zero. After treatment, anteroposterior changes in pogonion and vertical changes in menton were statistically insignificant (p>0.05). Our study demonstrated statistically significant stability of menton and pogonion positions after box genioplasty when surgical movement was only in the symphysis.

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.

Bone healing and stability after advancement genioplasty using a pre-bent absorbable plate and screws.

This study aimed to compare the bone healing and stability of the chin with a pre-bent absorbable plate and a manually bent absorbable plate after advancement genioplasty. Patients with class II malocclusion who underwent genioplasty with bimaxillary surgery were included. After genioplasty, two absorbable bicortical screws were fixed on both sides. Then, a pre-bent absorbable plate and screws were used in the center area to fix the segment in advancement genioplasty (PB group). A manually bent absorbable plate was used for the remaining patients (MB group). Computed tomography (CT) was performed before surgery and 1 week and 1 year after surgery. Changes in the pogonion (Pog) and menton (Me) points, soft tissue points, and the ratio of bone squares under the plate were evaluated using lateral cephalometric images reconstructed with 3-dimensional CT data. 32 patients were included in the study. There were no significant differences in the cephalometric measurements in the time interval from 1 week to 1 year. However, the bone square ratio in the PB group showed a significant increase after 1 year (P = 0.0021). Within the limitations of the study it seems that the use of a pre-bent absorbable plate is effective in promoting bone healing after advancement genioplasty.

Autoimmune diseases and orthognathic surgery: A case series of 12 patients.

Autoimmune diseases result from the immune system attacking native cells and tissues due to the recognition of "self" antigens as foreign antigens. This group of disorders is associated with an increased risk of complications after surgical interventions, as the immune system may cause tissue destruction. The study aimed to investigate the risk of surgical complications in patients with autoimmune diseases, who are at a higher risk of complications due to their condition. Among 886 patients who underwent orthognathic surgery, twelve types of autoimmune diseases with 22 patients were identified. For this case-series study, 12 patients were selected with a follow-up period of at least two years. The surgical procedures were executed by a single surgical team, which involved single or multi-piece Le Fort I osteotomy, Hunsuck/Epker modification of bilateral sagittal split osteotomy (BSSO), and/or genioplasty. The recorded outcome variables were postoperative adverse events, including respiratory or blood-related complications, wound infection, neurosensory disturbances, temporomandibular joint (TMJ) complications, and relapse. Only two patients recovered after surgery without any postoperative complications, whereas others had delayed recovery from neurosensory disturbance (5/12), infection (5/12), TMJ complications (2/12), and other complications. The findings of this study suggest that patients with autoimmune diseases undergoing orthognathic surgery are at higher risk of complications, highlighting the importance of careful consideration of patient selection and risk stratification before surgical intervention. The study also emphasizes the importance of close postoperative follow-up to detect and manage complications promptly.

Combined genioplasty, chondrolaryngoplasty, and glottoplasty: A novel scarless procedure in facial feminization surgery.

Facial feminization is a long process with multiple surgical steps that is known to improve quality of life in transgender patients. Visible scars are a frequent complaint by this community as it adds to the stigmatization in this population. Combined procedures have been shown to be effective, by reducing the number of hospitalizations and the total length of recovery periods. In this context, we propose a novel scarless procedure combining a chondrolaryngoplasty, a glottoplasty, and a genioplasty using solely a transoral approach. First, we perform a glottoplasty according to the technique described by Wendler et al. and then a contraction genioplasty. Finally, the thyroid cartilage is approached by a subplatysmal dissection, between the mandibular osteotomy fragments. For now, 15 patients have benefited from this procedure in our department. Preliminary results demonstrate that this is an easy and safe procedure with good esthetic results and good patient satisfaction.

Exploring the distribution of visual attention in genioplasty trainees using eye-tracking technology.

PURPOSE: This study aimed to investigate the visual attention of genioplasty trainees using eye-tracking technology, with the goal of providing insights for optimizing genioplasty training strategies. METHODS: Trainees were recruited for the study, and their visual attention distribution was monitored with an eye-tracking device while they watched a genioplasty procedure video. The percentage of fixation durations dedicated to areas of interest (surgical objects, instruments manipulated by the primary surgeon, and instruments controlled by assistants) were analyzed for each phase of the procedure. RESULTS: A total of 20 surgical trainees (8 males, 12 females; mean age, 27.8 years; range, 22-35 years) participated in the study. During the soft tissue reflection phase, trainees' percentage fixation durations on instruments controlled by the primary surgeon were higher than on surgical objects, but the difference was not significant (p > 0.05). The percentage fixation durations on instruments controlled by assistants were significantly lower than on those controlled by the primary surgeon or on surgical objects (p < 0.05). In the osteotomy, bone fixation, and suturing phases, the percentage fixation durations on surgical objects were highest, followed by instruments manipulated by the primary surgeon and those controlled by assistants, with significant differences (p < 0.05). CONCLUSION: Surgical trainees need to invest significant cognitive effort in focusing on the instruments manipulated by the primary surgeon and the surgical objects during the soft tissue reflection phase, as well as on surgical objects during the osteotomy, fixation, and suturing phases. Emphasizing these elements during instruction can help trainees reduce their cognitive load and effectively master genioplasty techniques.

The Versatile Role of Fat Injection During Various Genioplasties.

BACKGROUND: Fat injection has become increasingly popular in aesthetic surgery, but there is a sparsity of literature regarding its role during genioplasty. In this study, we present the largest series of patients receiving fat injections to the chin for various indications. METHODS: Data were collected from January 2016 to December 2021 for patients who underwent chin fat injection for a variety of chin refinements. Patients with chin fat injection were divided into isolated genioplasty with fat injection (CF), combined facial and chin fat injection (CFC) and combined chin fat injection and osseous genioplasty (CFG). Complication rates and reoperations were compared using Fischer's exact test between each cohort. RESULTS: 181 patients were included in final analysis, with 14 patients in CF cohort, 130 patients in CFC cohort, 24 patients in CFG cohort, and 13 patients who underwent genioplasty alone. Repeat fat injections were required in 17 (9.4%) patients overall, which included 14 patients (10.8%) of CFC subcohort and three patients (12.5%) of CFG subcohort (p > 0.05). No patients who underwent genioplasty alone or CF required reoperation. There were no significant differences in complications between genioplasty alone group (0%) in comparison to CF (7.1%; p = 1.00), CFC (6.2%; p = .53), or CFG cohorts (7.7%; p = 1.00). CONCLUSION: Fat injection can safely correct minor chin deficiency or asymmetry, as either an isolated procedure or in combination with osteotomies. Additionally, fat injection enables advancement of the caudal segment to achieve superior outcomes by preventing unaesthetic deepening of labiomental groove which will not be advanced during sliding osteotomy. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Alveolar bone changes in the mandibular incisors after genioplasty, a three-dimensional study.

INTRODUCTION: Functional genioplasty aims to achieve lip competence at rest and reduces lip pressure against the mandibular incisors. The purpose of this study was to describe the radiographic changes in alveolar bone of the mandibular incisors after functional genioplasty. MATERIALS AND METHODS: Cone beam CT images from 36 patients were compared between immediate (T0) and delayed postoperative period (T1). The mean time to complete the second imaging was 10.9 ± 4.7 months. Dental and bone parameters were assessed: the vestibular bone height (BH), the bone thickness (BT) with regard to the apex of the central incisor (BT2) and at equidistance between the cementoenamel junction and the dental apex (BT1). The existence of fenestrations, the apical-root resorption and the incisor-mandibular plane angle (IMPA) were also collected. RESULTS: No significant change occurred in the BH. BT was improved of a mean 47.9% and 53.6% at the BT1 level on #31 and #41, respectively (p1=0.01 and p2=0.02, respectively); and of 53.0% at the level of the apex of both mandibular central incisors (p1=0.003 on #31 and p2=0.009 on #41). No difference in the number of fenestrations was observed between T0 and T1. A significant decrease in the root length on both mandibular incisors was observed on the delayed CBCT (from 21.96 ± 1.35 to 21.68 ± 1.32 mm for #31, p=0.0007; from 22.26 ± 1.66 to 21.96 ± 1.48 mm for #41, p=0.002). Finally, the IMPA remained stable between the two examinations with a mean 106.1 ± 7.38° vs 105.8 ± 6.51° (p=0.38). CONCLUSION: Functional genioplasty favours the alveolar bone formation of the mandibular central incisors, probably by direct bone grafting, but also by the relaxation of the perioral and chin musculature.

Himi-Lengthening Genioplasty: A Modified Technique for the Correction of Mandibular Asymmetry.

Mandibular asymmetry is among the most common facial anomalies. Traditionally, mandibular asymmetry with malocclusion has been treated with orthognathic surgery and genioplasty. However, routine genioplasty cannot achieve a satisfactory contour. Hence, this study presents a modified technique, himi-lengthening genioplasty, to resolve this matter. By combining this technique with orthognathic surgery, the authors successfully corrected mandibular asymmetry in 1-stage surgery, achieved ideal occlusion, and reconstructed the esthetic contour. No complications occurred during the 6-month follow-up period. Therefore, the authors recommend our modified surgical technique for its effectiveness, security, stability, and simplicity.

Readmission after orthognathic surgery.

OBJECTIVE: To evaluate the readmission rate after orthognathic surgery and identify associated risk factors. STUDY DESIGN: Retrospective analysis of patients who underwent orthognathic surgery and had an unexpected hospital admission, with or without return to the operating room (OR), within the first postoperative year. Study variables included sex, age, American Society of Anesthesiologists (ASA) status, type of surgery, concomitant third molar extraction, concomitant genioplasty, duration of surgery, first assistant experience, and duration of hospitalization. Bivariate associations were calculated between variables and readmission status. Chi-square and Fisher's Exact tests were used to compare categorical variables, and a 2-sample t test was used to compare continuous variables. RESULTS: There were 701 patients included in the study. The readmission rate was 9.70%. Twelve patients were managed non-surgically, and 56 patients required an OR procedure. The most common reason for readmission without return to the OR was an infection, and for reoperation was hardware removal. Age, sex, type of surgery, third molar extraction, genioplasty, duration of surgery, and experience of first assistant were not found to be predictors for readmission. CONCLUSIONS: Only ASA classification and duration of initial hospitalization were significant risk factors for readmission of patients within the first postoperative year after orthognathic surgery.