Horizontal Flip Pedicled Genioplasty for Correction of Asymmetric Chin in Adult Unilateral Temperomandibular Joint Ankylosis

Abstract

It has been the desire and a great challenge to clinicians treating maxillofacial deformities to bring about symmetry in asymmetric faces. As one understands, it is very difficult to reproduce nature, that is, the normal side out of abnormal side, and it is easier to manage bilateral symmetrical deformities. Temporomandibular joint (TMJ) ankylosis, when it occurs in early childhood, will have devastating effects on the future growth and development of the jaws and teeth with obvious facial deformity including the chin, which worsens with advancing age and the time elapsed between the onset of ankylosis and the treatment instituted. We have been treating these chin deformities in adult unilateral TMJ ankylosis cases for over more than a decade with horizontal flip pedicled genioplasty, which has a mathematical basis of turning a scalene triangle to an isosceles triangle and thereby achieving symmetry. Fixation of the genial segment in an overriding position not only adds to the length of mandible but also overcomes the obstructive sleep apnea many times associated with TMJ ankylosis. We have successfully treated 15 patients using horizontal flip pedicled genioplasty during last 14 years. This instantaneous corrective and unique technique requiring minimal patient compliance is put forward with refinements developed during a period of years.