Genioplasty is one the procedures that have been widely accepted for correction of minimal craniofacial deformities and for those seeking cosmetic improvements.
Traditional osseous genioplasties are accomplished after exposing the symphysis area with an incision extending from lower first premolar area to the opposing lower first premolar. The mental foramina are identified and the horizontal osteotomy, usually performed with an oscillating saw, is made approximately 6 mm inferiorly, so as not to injure the inferior alveolar nerve, as it dips inferiorly prior to exiting the foramen, and to prevent any damage to the teeth roots. Depending on the deformity and required correction, the surgeon can alter the degree of movement of the osteomised segment to achieve the desired correction, before fixation with plates and screws. Orthognathic surgery generally has been traditionally considered an aggressive and highly morbid surgery in the term of length of procedures, blood loss, neurological and vascular risks, and time for patient recovery.
These complications play an important rule in patients’ refusal of the surgery. With the advent of different surgical technologies, such previously know as major procedures can be done with minimal complications achieving the described as “minimally invasive surgeries”. There are two minimally invasive techniques that can be used in orthognathic surgeries, used separately or in combination: 1) Endoscopic surgeries and 2) Piezosurgeries.
The use of endoscopy allows direct visualization of a magnified and illuminated operative field while requiring only small and remotely placed incisions in inconspicuous locations with minimal dissection. It was firstly used in pterygomaxillary disjunction in Le Fort osteotomy, then the uses increased widely in orthognathic surgeries. It showed decreased complication rates, comparable success rates, diverse functionality, and efficiency make it a helpful instrument in a surgeon’s armamentarium.Piezosurgery is a promising, meticulous and soft tissue- sparing system for bone cutting, based on ultrasonic microvibrations. It was developed by Italian oral surgeon Tomaso Vercellotti in 1988 to overcome the limits of traditional instrumentation in oral bone surgery by modifying and improving conventional ultrasound technology.
Not only is this technique clinically effective, but histological and histomorphometric evidence of wound healing and bone formation in experimental animal models has shown that tissue response is more favorable in piezosurgery than it is in conventional bone-cutting techniques such as diamond or carbide rotary instruments. The use of piezosurgery for orthognathic procedures has gained considerable impetus in recent years, being used for such operations as the bilateral sagittal split osteotomy, surgically assisted rapid maxillary expansion, and Le Fort I osteotomy. The use of piezosurgery in genioplasty procedures have showed superior outcomes to the traditional surgeries in term of the degree of inflammation, pain, swelling and patients satisfaction (Rullo, Festa et al.
2016). The use of endoscopy in genioplasty surgeries hasn’t been discussed. Therefore, the aim of this study is to introduce a technique combining piezosurgery and endoscopy for genioplasty procedures and comparing it to the traditional genioplasty procedure.