From the Division of Plastic and Reconstructive Surgery, Zucker School of Medicine at Hofstra/Northwell; Division of Plastic and Reconstructive Surgery, Temple University; and Division of Plastic and Reconstructive Surgery, University of California, Los Angeles.
Plast Reconstr Surg. 2021 Nov 1;148(5):720e-726e. doi: 10.1097/PRS.0000000000008478.
Osseous genioplasty is a powerful procedure that can correct chin dysmorphology; however, traditional techniques may result in chin ptosis or a "witch's chin" deformity. Iatrogenic chin ptosis is thought to be caused by excessive degloving of soft tissue with a failure to reattach the mentalis muscle. In the authors' study, they compared the "no-degloving" technique (using a 90-degree plate with lag-screw fixation) to the "traditional" technique, for minimization of chin ptosis.
The authors compared genioplasty techniques for consecutive patients: group 1 (traditional) underwent degloving for fixation of a stair-step plate, whereas group 2 (no-degloving) underwent lag-screw fixation (n = 50; 25 patients per group). The authors compared operating room time, advancement, complications, preoperative-to-postoperative vertical height change of the pogonion and menton (obtained through cone beam computed tomographic scans), surgeons' assessment of witch's chin, and FACE-Q surveys.
No-degloving versus traditional groups had similar age and sex distributions, horizontal/vertical change (5 mm/2 mm versus 6 mm/2 mm), length of surgery, and complication rate (5 percent). The traditional group had more deviation from expected position for both the pogonion (3.4 mm versus 1.2 mm; p ≤ 0.05) and menton (2.9 mm versus 0.8 mm; p ≤ 0.05), and more occurrences of witch's chin (six versus zero). No-degloving was superior for several FACE-Q scales, including Chin Appearance, Quality of Life, Satisfaction with Decision to Undergo Procedure, and Satisfaction with Outcome.
No-degloving osseous genioplasty is a safe, reproducible technique that results in decreased soft-tissue ptosis and increased patient satisfaction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
骨性下颌前突整形术是一种强大的术式，可以矫正下颌畸形；然而，传统技术可能导致下颌下垂或“巫婆下巴”畸形。医源性下颌下垂被认为是由于软组织过度剥离而未能重新附着颏肌所致。在作者的研究中，他们比较了“无剥离”技术（使用 90 度钢板和拉力螺钉固定）与“传统”技术，以减少下颌下垂。
作者比较了连续患者的下颌前突整形技术：第 1 组（传统）为固定阶梯钢板进行剥离，而第 2 组（无剥离）进行拉力螺钉固定（n = 50；每组 25 例）。作者比较了手术室时间、推进程度、并发症、术前术后颏顶点和颏下点（通过锥形束 CT 扫描获得）的垂直高度变化、外科医生对巫婆下巴的评估以及 FACE-Q 调查。
无剥离组与传统组的年龄和性别分布、水平/垂直变化（5mm/2mm 与 6mm/2mm）、手术时间和并发症发生率（5%）相似。传统组颏顶点（3.4mm 与 1.2mm；p ≤ 0.05）和颏下点（2.9mm 与 0.8mm；p ≤ 0.05）的预期位置偏差更大，巫婆下巴的发生率更高（6 例与 0 例）。无剥离在几个 FACE-Q 量表上表现更好，包括颏部外观、生活质量、对手术决策的满意度和对结果的满意度。
无剥离骨性下颌前突整形术是一种安全、可重复的技术，可减少软组织下垂，提高患者满意度。
临床问题/证据水平：治疗性，III 级。
