Genioplasty: Method and duration of the intervention
For genioplasty, after lifting the mucosa (intraoral approach), the detachment is extended laterally to the mental foramina…
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Anesthesia
Mentoplasty is an operation that can be performed under general anesthesia or under local anesthesia and sedation (administration of sedative drugs intravenously in order to maintain a state of drowsiness and tranquility), and again only under local anesthesia. If under sedation, the local anesthetic is administered when the patient is asleep, in order to eliminate even the slightest discomfort due to the injection. Generally, the implantation of a chin prosthesis is performed under local anesthesia, while the genioplasty under local anesthesia assisted by sedation. Whatever procedure it is, there is no pain during the operation. The choice of the type of anesthesia can be discussed with the surgeon and the anesthetist. In any case, it must meet all the maximum security requirements.
Method and duration of the intervention
According to individual cases and preferences, the intervention can be carried out on an outpatient basis, in daytime hospitalization only or with overnight stay. The experience accumulated by each surgeon leads him to prefer particular execution techniques and patient management methods.
The intervention has a variable duration, generally from one to two hours, according to the technique used; complex cases can take longer.
For additive mentoplasty using prostheses, two main ways of execution are recognized:
1. “Submental approach”, where the incision is made externally approximately 5 mm below the natural submental fold;
2. “Intraoral approach”, in which the oral mucosa is incised from canine to canine about 5 mm below the insertion of the adherent gingiva, sparing the frenulum; or one or two small incisions are made in the mucosa at the level of the canine, vertically for a few centimeters.
In the first case, once the incision has been made (a few centimeters long), the skin and subcutaneous tissues are mobilized from the underlying skeleton with a detachment towards the lower edge of the mandibular symphysis, dividing the insertions of the platysma (superficial muscle of the neck) from the margin mandibular and exposing the periosteum along the symphysis. In a precise and symmetrical way a pocket is thus packaged in a usually subperiosteal plane. The pocket that accommodates the prosthesis is made so that the implant is placed directly along the mandibular edge and does not extend higher than the labio-chin pit. After the insertion of the prosthesis, the submental fat and the platysma muscle fascia are brought together and sutured. The operation ends with the suturing of the skin and generally with a modestly compressive dressing.
In the intraoral incision, the mandibular symphysis is exposed by lifting the mucosa. We proceed with the packaging of a precise pocket and the position of the implant. In this case, the operation ends with the mucous suture.
For genioplasty, after lifting the mucosa (intraoral approach), the detachment is extended laterally to the mental foramina (emergency points of the mandibular nerves), in order to avoid trauma to the nerve trunks during the operation. A horizontal osteotomy is then performed. Once the mobilization of the mental segment is complete, different placements or procedures can be performed. More frequently, the lower segment is simply advanced, resulting in a transverse increase of more than 10 mm. At other times it can be reduced in height to decrease the vertical dimension of the face or, in other cases, increased in height. After the osteotomy and the new position, the mental bone segment is immobilized with rigid fixation to the mandibular symphysis using mini plates and screws or staples.
As often happens in Plastic Surgery, it is a complex intervention and not a routine uniformity, in the sense that the procedure is not completely standardizable, but is customized on the basis of individual characteristics.
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