Sliding Osseous Genioplasty and Coronoidectomy in a Patient with Treacher-Collins Syndrome
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Author: Michael Golinko
Published:
Specialties: Plastic Surgery
Schools: Arkansas Children's Hospital
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Loading...Contributors: Andrew Weaver and Kumar Patel, PA-C
18 y.o. female with Treacher-Collins syndrome (patients have micrognathia, underdeveloped facial bones, particularly the cheek bones, and a very small jaw and chin. She is only able to open her mouth to 20mm due to the interference of her coronoid process with her zygoma/
Procedure
Right Coronoidectomy & Sliding Osseous Genioplasty
Indications
: Coronoidectomy: increased jaw pain, limited incisal opening due to CT confirmed hyperplastic coronoid; Genioplasty: microgenia, asymmetric chin, chin recession
Contraindications
: extremely thin bone that cannot be plated, co-morbidities increasing surgical risk.
Instrumentation
Setup
Supine, nasal intubation
Preoperative Workup
history & physical, CBC, CMP, PT/INR 3D 1mm cut head/facial bone CT, standardized photographs
Anatomy and Landmarks
Coronoidectomy: intra-oral incision, watch for 'dimple' of Stensen's duct in the region of the 2nd molar; must identify the Sigmoid notch and start osteotomy at that level
Genioplasty: the course of the inferior alveolar nerve exiting the mental formamen usually ~ 5mm below this foramen between the 1 and 2nd pre-molars
Advantages/Disadvantages
Coronoidectomy: improved incisal opening, but without exercises post-operatively risk of contracture fibrosis
Genioplasty: improved facial balance harmony & aesthetics, mental nerve injury, step-off deformities
Complications/Risks
fibrosis of Temporalis muscle, Witches-chin deformity if the mentalis muscle is not re-suspended properly.
Disclosure of Conflicts
fibrosis of Temporalis muscle, Witches-chin deformity if the mentalis muscle is not re-suspended properly.
Acknowledgements
Jessica Boswell for helping to film
References
a. Soft Tissue Response After Chin Advancement Using Two Different Genioplasty Techniques." ResearchGate. N.p., n.d. Web. 24 Feb. 2016.
b. "One-Stage Treatment to Condylar Osteochondroma Combined With... : Journal of Craniofacial Surgery." LWW. N.p., n.d. Web. 21 Feb. 2016.
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