Stalder Mark W, St Hilaire Hugo
Division of Plastic and Reconstructive Surgery, Louisiana State University School of Medicine, New Orleans, Louisiana 70112, USA.
J Craniofac Surg. 2012 Sep;23(5):e446-7. doi: 10.1097/SCS.0b013e318260ebf7.
Genioplasty is a useful tool for correction of congenital abnormalities, as well as for aesthetic improvements of the lower face. Both alloplastic implantation and osseous genioplasty techniques have long been used successfully to achieve satisfactory outcomes. However, alloplastic implantation can be associated with several known complications, including infection, bone resorption, and secondary soft tissue deformities. Typically, these issues arise in the early postoperative period, but there have been reported instances of late infectious complications and the associated sequelae. These cases are generally treated with removal of the implant and secondary revision at a later date. We present here the unique case of a 65-year-old woman who presented with an infected silicone chin implant 25 years after her initial surgery. In this case, we chose to perform an immediate osseous genioplasty at the time of implant removal to avoid the problems that can arise from unpredictable soft tissue healing, as well as an untoward aesthetic result from the significant bone resorption that had occurred in this patient. To minimize the presence of exposed hardware in this contaminated field, we used intraosseous Kirschner wire fixation for osteosynthesis of the advanced genial segment. Our patient experienced no complications from this procedure, the infection cleared, and a successful aesthetic outcome was achieved with this technique.
颏成形术是矫正先天性畸形以及改善下脸部美观的一种有效手段。异体植入和骨性颏成形术技术长期以来都成功用于取得满意的效果。然而，异体植入可能会伴有多种已知并发症，包括感染、骨吸收以及继发性软组织畸形。通常，这些问题出现在术后早期，但也有晚期感染并发症及相关后遗症的报道。这些病例一般通过取出植入物并在日后进行二次修复来治疗。我们在此呈现一位65岁女性的独特病例，她在初次手术后25年出现了硅胶下巴植入物感染。在该病例中，我们选择在取出植入物时立即进行骨性颏成形术，以避免不可预测的软组织愈合可能引发的问题，以及该患者因大量骨吸收导致的不良美学效果。为尽量减少在这个受污染区域中暴露的硬件，我们使用骨内克氏针固定来对前移的颏部节段进行骨合成。我们的患者在此次手术中未出现并发症，感染消除，并且通过该技术获得了成功的美学效果。
