Demineralized Bone Matrix in Osseous Genioplasty: Long-term Follow-up
Daniel C. Sasson1, Alexandra Junn1, Adam Junn1, Aaron Long1, Sara Islam1, Sarah Phillips1, Joseph Lopez1, Tulsi Roy1, Derek Steinbacher1
1Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
BACKGROUND: Osseous genioplasty is a powerful technique used to alter chin prominence and improve facial aesthetics. One drawback to this procedure, however, is the development of an intersegmental gap and lateral stepoffs, particularly in cases of significant advancement. While demineralized bone matrix (DBX) has been used as an adjunct or alternative to autologous bone graft at Le Fort I osteotomy sites and alveolar cleft repair, the evidence in favor of DBX in osseous genioplasty remains limited. The purpose of this study is to investigate the long-term efficacy and outcomes of the use of DBX in patients undergoing osseous genioplasty.
METHODS: A retrospective chart review was conducted of all patients at a single institution undergoing osseous genioplasty using DBX from 2013-2021. Demographic information, surgical indication, type of genioplasty, and size of offset of the plate were obtained for each patient. Post-operative complications of infection, tooth root loss, implant removal, persistent pain at osteotomy site (>3 months), hardware loosening, hardware extrusion, and return to the OR for hardware removal were recorded. Bony healing and callus formation within the osteotomy site was assessed on visual radiographic interpretation and objectively measured using Hounsfield Units (HU) within a best fit oval region of interest that included the tissue within the osteotomy at the midpoint between the upper and lower segments of the plate.
RESULTS: A total of 262 patients were included in this study, with 13.8% undergoing shortening, 6.1% undergoing lengthening, 35.6% undergoing advancement, and 44.4% undergoing lengthening and advancement genioplasty. The mean size of the offset was 5.71 ± 2.16 mm. 74% underwent concurrent orthognathic surgery and 5% underwent concurrent rhinoplasty. Of 47 patients who received postoperative computed tomography at least 3 months after surgery (28.14 ± 22.88 months), all demonstrated bony healing on visual assessment of the scan, with 583.62 ± 197.92 HU in the intersegmental gap. 94.3% of patients experienced no genioplasty-related complications, while 4.9% of patients experienced infection and 1.5% reported residual pain at the osteotomy site greater than 3 months after surgery. 2 patients required hardware removal.
CONCLUSIONS: The use of intersegmental DBX in osseous genioplasty is safe, with complication rates comparable to procedures performed without DBX. Similar to Le Fort I osteotomy and alveolar cleft repair, the use of DBX in osseous genioplasty is effective as well, as shown by successful bony healing on postoperative imaging.
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