Chin surgery IV: the large chin--key parameters for successful chin reduction.
Barry M Zide, Stephen M Warren, Jason A Spector
Author Information
Barry M Zide: New York, N.Y. From the Institute of Reconstructive Plastic Surgery, Division of Plastic Surgery, New York University School of Medicine, and the Division of Plastic Surgery, Weill Cornell College of Medicine, Cornell University, New York Presbyterian Hospital.
BACKGROUND: Treatment of macrogenia can be a challenging problem. In this article, the authors provide novel insights for treatment of a previously poorly treated problem. The authors have developed anatomical insights that facilitate the subtly difficult preoperative evaluation of the large chin and, when applied appropriately, will provide uniformly pleasing results. METHODS: A retrospective review of the senior author's (B.M.Z.) patient records was performed. More than 50 cases of macrogenia were identified. As previously described, almost all of the cases were performed under local anesthesia with oral premedication only. RESULTS: This article demonstrates why prior modalities such as intraoral burring and lower border setback failed to treat the variety of large chins properly. The nine critical factors the surgeon must consider in developing a successful surgical plan are outlined. The surgical plan is not primarily based on radiographs as much as on direct tactile and visual analysis of the sublabial structures both in repose and while smiling. Crucial aspects of the operative technique are highlighted. CONCLUSIONS: The large chin can be approached with confidence if nine parameters are appreciated. The authors have outlined these key variables that facilitate proper preoperative topographic analysis of the large chin. Once these variables are appreciated, an appropriate surgical plan can be formulated.
References
McCarthy, J. G., Ruff, G. L., and Zide, B. M. A surgical system for the correction of bony chin deformity. Clin. Plast. Surg. 18: 139, 1991.
McKinney, P., and Rosen, P. B. Reduction mentoplasty. Plast. Reconstr. Surg. 70: 147, 1982.
Simons, R. L., and Lawson, W. Chin reduction in profileplasty. Arch. Otolaryngol. 101: 207, 1975.
Hohl, T. H., and Epker, B. N. Macrogenia: A study of treatment results, with surgical recommendations. Oral Surg. Oral Med. Oral Pathol. 41: 545, 1976.
Ousterhout, D. K. Sliding genioplasty, avoiding mental nerve injuries. J. Craniofac. Surg. 7: 297, 1996.
Posnick, J. C., Al-Qattan, M. M., and Stepner, N. M. Alteration in facial sensibility in adolescents following sagittal split and chin osteotomies of the mandible. Plast. Reconstr. Surg. 97: 920, 1996.
Bell, W. H., Brammer, J. A., McBride, K. L., et al. Reduction genioplasty: Surgical techniques and soft-tissue changes. Oral Surg. Oral Med. Oral Pathol. 51: 471, 1981.
Lindquist, C. C., and Obeid, G. Complications of genioplasty done alone or in combination with sagittal split-ramus osteotomy. Oral Surg. Oral Med. Oral Pathol. 66: 13, 1988.
Nishioka, G. J., Mason, M., and Van Sickels, J. E. Neurosensory disturbance associated with the anterior mandibular horizontal osteotomy. J. Oral Maxillofac. Surg. 46: 107, 1988.
Zide, B. M., Pfeifer, T. M., and Longaker, M. T. Chin surgery: I. Augmentation—the allures and the alerts. Plast. Reconstr. Surg. 104: 1843, 1999.
Zide, B. M. The mentalis muscle: An essential component of chin and lower lip position. Plast. Reconstr. Surg. 105: 1213, 2000.
Zide, B. M., and Boutros, S. Chin surgery III: Revelations. Plast. Reconstr. Surg. 111: 1542, 2003.
Robinson, P. P. Observations on the recovery of sensation following inferior alveolar nerve injuries. Br. J. Oral Maxillofac. Surg. 26: 177, 1988.
