[Genioplasty alone and in combination. Long-term results with emphasis on sensitivity and photoanalysis].
OBJECTIVE
Striving for beauty and expressiveness is a deeply rooted human attitude. The lower jaw-especially the mentum-plays an important role in the perception of the face as an instrument of communication. According to Grammer a distinctive lower jaw is an essential characteristic feature of male attractiveness.


METHODS
During a period of 10 years 58 patients underwent genioplasty. A follow-up examination was performed in 49 patients (complete sensitivity evaluation: 33 patients, complete photoanalysis: 30 patients). To reduce radiation due to cephalometric radiography a simple photometric method for cephalometry was developed and applied. Particular attention was directed at sensitivity of the mental nerve after genioplasty.


RESULTS
To the best of our knowledge, this is the first time that photos of the right profile were compared with those of the left side. Unexpectedly, intraindividual differences dependent on the facial side (right and left) could be found in the relationship of the lower to the upper face and in the proportion of the profile angle and the nasomental angle. After three-dimensional genioplasty these differences were reduced and facial asymmetry was improved. Comparing the right with the left side the average difference of the nasomental angle was reduced from 2.5 degrees to 0.6 degrees on average. The profile angle was changed by genioplasty from 19 degrees on average to 15 degrees ("ideally" 10 degrees , the so-called upright face). According to Schwarz the ideal height of the mentum (stomion-menton) should amount to 66% of the total lower face. Especially by combined dorsal and cranial positioning of the mentum a reduction from 85 to 68% was achieved. Postoperatively 24 of 33 patients (73%) showed disturbances of the mental nerve. After at least 1 year following the operation, normal sensitivity of the lower lip and chin of both sides was evaluated by almost all of these patients (19 of 24 = 79%). Especially all patients having had only a single genioplasty recovered totally from a neurosensory deficit.


CONCLUSIONS
Genioplasty can be considered to be a reliable procedure to achieve harmony of the lower face.
Driemel
O
O
Klinik für Mund-, Kiefer- und Gesichtschirurgie/Plastische Operationen, HELIOS Klinikum Erfurt. odriemel@erfurt.helios-kliniken.de.
Kloss
F
F
Roth
B
B
Würzler
K K
KK
Pistner
H
H
D000293:Adolescent; D000328:Adult; D002508:Cephalometry; D002680:Chin / Q000294:innervation / Q000601:surgery*; D003131:Combined Modality Therapy; D005146:Facial Asymmetry / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D010781:Photography; D011183:Postoperative Complications / Q000175:diagnosis*; D012678:Sensation Disorders / Q000175:diagnosis*; D013518:Surgery, Plastic