Hoenig Johannes Franz
University Hospital and Medical School of Goettingen, Plastic Surgery Center, Paracelsus Clinic, Hannover, Germany.
Aesthetic Plast Surg. 2007 Jul-Aug;31(4):384-91. doi: 10.1007/s00266-006-0177-6.
The chin, one of the most obvious facial structures, plays an important role in the perception of the face as an instrument of communication. To alter the chin contour in a reliable manner, horizontal sliding osteotomy of the mandibular symphysis with advancement of the mobilized segment is the technique of choice for correction of the anterior posterior deficiency. This study describes surgical techniques used in aesthetic and functional surgery of the chin as well as the outcomes. Over a 10-year period, 474 patients underwent orthognathic surgery for correction of their malocclusion. Of these 474 patients, 155 were treated in combination with a sliding genioplasty (SGP) and 37 (29 women and 8 men; average age, 32 years; range, 18-47 years) had an isolated SGP. Of these patients, 33 had chin advancement and 4 had chin reduction. The mean chin advancement was a modest 4.5 mm (range, 2-7 mm), and the mean chin vertical displacement was 3.9 mm (range, 2.5-4.1 mm). All the patients in the mandibular deficiency group had a residual sagittal disproportion of the progonion relative to the subnasale (mean, -7.6 mm) and a newly created vertical disproportion, with mean lower face heights of 67.8 mm compared with mean midface heights of 65.3 mm. The surgical outcome was evaluated by analysis of pre- and postoperative photographs, analysis of pre- and postoperative measurements, and patients' self judgment. All the patients healed uneventfully without any major postoperative problems. Paraesthesia of the mental nerves occurs to some degree in almost all patients measured by the Simmon Weinstein diagnostic device. In the single sliding chin osteotomy group, no major branches of the mental nerves were transacted. Paraesthesia was only transient, usually lasting for only a few weeks. At least 1 year after the operation, normal sensitivity of the lower lip and both sides of the chin was reported by almost all of the patients (93.1%). All who had only a single genioplasty recovered totally from a neurosensory deficit. The level of satisfaction was significantly high for all the patients. The results were judged to be excellent in 73.2% and good in 23.6% of the cases. Only in 3.2% of the cases was it considered to be poor (bimaxillary surgery combined with SGP). The current findings strongly suggest that SGP is a reliable procedure for achieving harmony of the lower face. In addition, it permits a simplification of facial reconstruction and rejuvenation. The combination of chin advancement and submental recontouring can have a positive effect on facial appearance, provided the increased chin projection is appropriate.
下巴是面部最明显的结构之一，在将面部视为交流工具的认知中起着重要作用。为了可靠地改变下巴轮廓，下颌联合部水平滑动截骨术并推进移动节段是矫正前后部不足的首选技术。本研究描述了下巴美学和功能性手术中使用的手术技术以及手术效果。在10年期间，474例患者接受了正颌手术以矫正错牙合畸形。在这474例患者中，155例接受了滑动颏成形术（SGP）联合治疗，37例（29名女性和8名男性；平均年龄32岁；范围18 - 47岁）接受了单纯SGP治疗。在这些患者中，33例进行了下巴前移，4例进行了下巴后缩。下巴平均前移幅度为适度的4.5毫米（范围2 - 7毫米），下巴平均垂直移位为3.9毫米（范围2.5 - 4.1毫米）。下颌骨不足组的所有患者相对于鼻下点颏前点均存在矢状面残余不对称（平均为 - 7.6毫米）以及新出现的垂直不对称，平均下面高为67.8毫米，而平均中面高为65.3毫米。通过术前和术后照片分析、术前和术后测量分析以及患者自我判断来评估手术效果。所有患者均顺利愈合，术后无任何重大问题。几乎所有通过西蒙·温斯坦诊断设备测量的患者在某种程度上都出现了颏神经感觉异常。在单纯滑动下巴截骨术组中，颏神经的主要分支未被切断。感觉异常只是暂时的，通常仅持续几周。术后至少1年，几乎所有患者（93.1%）报告下唇和下巴两侧感觉正常。所有仅接受一次颏成形术的患者神经感觉功能障碍均完全恢复。所有患者的满意度都非常高。73.2%的病例结果被判定为优秀，23.6%为良好。只有3.2%的病例（双颌手术联合SGP）被认为较差。目前的研究结果强烈表明，SGP是实现下面部和谐的可靠手术方法。此外，它还能简化面部重建和年轻化手术。下巴前移和颏下轮廓重塑相结合可以对面部外观产生积极影响，前提是下巴突出增加量合适。
