Postoperative Complications in Genioplasty and Their Association with Age, Gender, and Type of Genioplasty

Objective. The objective of our study was to determine the incidence of postoperative complications associated with different kinds of genioplasties done with or without concomitant orthognathic surgeries. Materials and Methods. Patients in whom facial asymmetry was corrected by genioplasty with age ranging from 16 to 55 at the Department of Oral and Maxillofacial Surgery were included in the study. Patients with facial asymmetry due to congenital problems were excluded. Results. 59 patients were included, of which 38 were males and 21 were females with the age range of 16–55 (mean: 27.3729, Std. deviation: 4.70472). Advancement genioplasty was performed in 15.3%, reduction genioplasty was done in 16.9%, and advancement genioplasty with rotation was performed in 67.8% cases. In 28.8% cases, genioplasty was performed as an adjunct procedure with orthognathic surgery, and in 71.2% cases, genioplasty was performed alone. 3.4% patients developed infection, 8.5% had hematoma, and 6.8% had temporary numbness. Postoperative complications were seen more in men than in women. Correction of chin asymmetry by rotation/advancement showed the highest number of complications (84%). Conclusion. Temporary neurosensory disturbance of the inferior alveolar nerve is the most common complication that occurs after genioplasty. Patients shall be counselled preoperatively, and informed consent shall be obtained prior to surgery.

Principalization of the Anatomical Subunit Approximation Technique of Unilateral Cleft Lip Repair

Background: The Anatomical Subunit Approximation cleft lip repair advantageously achieves a balanced lip contour with the line of repair placed along seams of aesthetic subunits. Since Fisher’s original description, it has been adopted widely and adapted, but some surgeons find the transition away from a cut-as-you-go approach challenging. Methods: We present an adapted Anatomic Subunit Approximation technique based on essential components of Fisher’s repair. The order of surgical execution is emphasized. Paradigm shifts are presented to help the surgeon used to more traditional rotation advancement techniques understand the Subunit philosophy. Minor adaptations such as surgically releasing lateral lip elements prior to marking are discussed. Results: A total of 53 eligible patients were treated with unilateral cleft lip repair by the senior author (D.C.) between February 2008 and April 2012 at Royal Children’s Hospital in Melbourne, Australia. Representative cases were chosen to demonstrate achievable results with the described technique. Conclusion: The proposed technique employs essential skin markings to achieve an anatomic subunit approximation lip repair, and appears to facilitate surgical outcomes with a high degree of symmetry. Core principles of repair include precise anatomical planning, tissue component separation, and muscle-driven advancement.

A Rare Case: Primary Venous Malformation in Parietal Bone

Primary intraosseous vascular malformations (PIVMs) are rare intraosseous lesions, accounting for approximately 0.5–1% of all intraosseous tumours. In this case report, we aimed to present a rare case of intraosseous vascular malformation causing a large lytic area in the parietal bone. A 25-year-old male patient was admitted to the clinic with a mass on the parietal bone. On physical examination, it was observed that the hair density on the mass was decreased, the mass had a soft consistency, and there was no pain on palpation. The patient was operated under local anaesthesia with a provisional diagnosis of a trichilemmal cyst. However, intraoperative diagnosis was a vascular malformation. There was a 3-cm full-thickness defect on the parietal bone caused by the lesion. The mass was excised completely while preserving the integrity of the dura. The resulting defect was reconstructed with bilateral rotation advancement flaps. The calvarial defect was not reconstructed due to equipment inadequacy. No complications were encountered in the postoperative period. Ninety-three PIVM cases have been reported in the skull since 1845. In very few of these cases, the mass is located in the parietal bone. The pathogenesis of PIVMs is not completely understood. The definitive diagnosis is made by histopathological examination. The therapeutic gold standard is surgery. Surgeons should keep in mind that radiological examination before the operation could prevent undesirable complications.

Cleft Lip

Many techniques exist at present for surgical repair of primary cleft lip. Since the introduction of Millard, most of the techniques are based on Millard’s Rotation advancement principle. However, every cleft surgeon aims to modify his/her technique to achieve optimum symmetry and function of the nose and lip. In this chapter, we have presented the principles of lip repair followed at our centre based on the very principles of Millard. We have also discussed embryology and anatomy from a surgical pint of view so as to understand the anatomic basis if cleft surgery.