Invited Discussion on: A Modified Cosmetic Genioplasty Can Affect Airway Space Positively in Skeletal Class II Patients:
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EDITOR’S INVITED COMMENTARY
Invited Discussion on: A Modified Cosmetic Genioplasty Can Affect Airway Space Positively in Skeletal Class II Patients: Studying Alterations of Hyoid Bone Position and Posterior Airway Space Barry M. Zide1
Received: 18 May 2020 / Accepted: 23 May 2020 Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020
EBM LEVEL V I just reviewed the paper on the use of modified advancement genioplasty for obstructive sleep apnea on a small number of patients none of whom had sleep apnea. Also, in this article, genioplasty alone was used for cosmetic correction of class II malocclusion with micrognathia wherein only the chin was treated, perhaps the patients declined orthognathic surgery. Because the micrognathia patients had chin retrusion as part of the deformity, and the surgeons treated just that with a bit more than typical advancement, the airway increased according to the measurements. And since airway size increase would be helpful for obstructive sleep apnea, this operation which was not used here to treat that problem is presented as a method to treat it. All surgeons (meaning you) are given the dilemma: Should I do the ideal operation or an easier one that I am more comfortable doing? Should a class II micrognathia/ microgenia patient with a compromised airway get a sagittal split proven to open the airway or a chin operation which is less effective, and certainly does not treat the entire deformity? Without references, sorry, (easy to check) a bilateral sagittal split with months of orthodontia preop and postop will bring the mandible forward and downward opening the airway in nonsyndromic patients.
& Barry M. Zide [email protected]; [email protected] 1
Plastic Surgery, NYU Langone Health, 222 East 41st St/7th Floor, NYC, New York, NY 10017, USA
The chin will be more prominent, and the vertical height of the face will be increased. Conversely for prognathism, the same operation done as a setback acutely decreases the airway with later partial relief after healing. Here, we have patients who may not want to undergo preliminary braces and postop braces as an adult, so the surgeons offer a chin operation. As the chin does appear short from the front as well as much more retruded, the patient gets a more aggressive symphyseal osteotomy with advancement and down placement. If this operation was required with a bilateral sagittal split osteotomy, the advancement at the chin would be less and down fracture unnecessary as the occlusion with bilateral sagittal split osteotomy correction usually does this. The average advancements in these cases were greater than usual and the down fracture presented kept the chin from looking too short. The authors hypothesized that the down fracture also assists somehow in opening the airway. It likely does not. In addition, the authors state that they maintain contact of the bone posteriorly so that healing is expedited. It is the surgeon’s preference whether or not he decides to pu
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