Sliding Genioplasty - concerns about plate removal / nonunion

[improvedchin]

Hello,

I have a few questions regarding sliding genioplasty.

Here is my story:

Seeking to increase horizontal projection on my recessed chin (lack of projection), I opted into having a sliding genioplasty back in 2014; the results, however, did not meet my expectations, as my chin still appeared recessed. Apparently there was relapse during the first few weeks of recovery (total advancement was ~8mm). Steel wires utilized to secure the bone back together (no titanium plate).

Wanting to fix this, I had my second surgery around 3.5 months later. The second surgeon told me I was advanced around ~4mm (so this does indeed imply there was some sort of relapse). He removed the steel wires, retraced the initial cut, and advanced my chin around ~7-8mm. This time, a titanium plate was used for fixation. I don't think there was any relapse this time.

My questions are as follows:

1. I am now around 1 year and 2 months post-op, and I'm having no real issues other than some mild tightness in my chin / lower gum area. There is also some mild pain in the surgical spot on occasion that comes and go randomly. Has anyone experienced either one of these symptoms this far out?

2. I strongly desire to remove this titanium plate sometime down the road, but I'm concerned my chin will relapse or go back to its original place without the plate holding it in place. Does anyone in particular have any information on chin stability without the plate? I would love to hear some stories about the removal of these plates.

3. Will strenuous activity this far out increase the likelihood of a relapse?

4. I'm aware that nonunion can be a complication; how likely is something like this to occur? Has this happened to anyone here? If so, what are some symptoms to be aware of? Other than x-rays, how can this be diagnosed?

Looking forward to your responses back.

Thanks in advance.

[asphyxia]

Hi

I had a genioplasty as well, using titanium screw, and I'm now looking to have a second procedure done because I felt the first one was not enough projected.Wires are less used lately, especially because they're reported to have less stability down the line, which you learnt the hard way unfortunately.With titanium screws, you don't have to worry about this anymore.If a relapse occurs, it will be likely due to bone remodeling, and only be clinically noticeable.Maybe the tightness you're experiencing is due to late nerve recovery?
Usually, titanium plates are not removed afterwards, because bone builds up around it, and it might be a little difficult to get out.If you don't really have to, I would advise you not to do it.Anyway, the bone will stay in place once it's healed, which,after one year, is the case for you.Again, if you had a nonunion, I think you would have noticed it already, so I wouldn't worry about it by now...As for the activity, you can resume it with no problem, bone has fully healed.

Hope it helps

[asphyxia]

If I can ask you a question in return : how  did your revision feel, 3 months after the first procedure? i suppose your surgeon had to do another osteotomy following the previous one? Was it an issue? How was the recovery compared to the first one? I'm afraid my advancement is too conservative and that my surgeon might be reluctant to go in there one more time...

[improvedchin]

Hi, thanks for the informative response. I recovered rather well after my revision actually. From what I recall, I wasn't in a significant amount of discomfort or anything like that. I think my surgeon did a really good job overall. I was advanced around 7-8mm the second time around. Yes, he had to retrace the original cut. I was concerned about nonunion because right after surgery, I heard clicking noises; I was afraid the bone was moving around... Have you experienced this before? Also, how would I know if there was a nonunion?

Yeah, I went back in for a revision because I felt I wanted more projection after my first surgery. How much were you advanced?

Do you also feel tightness and/or mild pain in your chin area?

I am now about 1 year and 2 months post op, and recently started lot of acrobatic exercises, so I was afraid the strenuous activity may induce relapse.

How long are you post-op again?

Looking forward to hearing back. Thanks!

[asphyxia]

Hi,you're welcome.Then again, if guess that if you had nonunion, you would experience some inflammation in the chin area,since you're body would still trying to find a way to "protect" the cut.Does it make sense?
I think that given the fact you had two surgery in a short time period, the tightness you experience isn't unusual, although you might want to consult your surgeon if it worries you, just to be reassured.You know, nonunion is rather unlikely, and unless you have some underlying bone issues, I wouldn't be concerned about it.For instance, I am young, but I have do have osteopenia and my bone has already fused back together.
As for the risk of relapse, I think 1 year is safe,although bone remodeling occurs on a very long term basis, and can be unpredictable.But you certainly don't want to stay away from exercising for 3 years or so...So, my advice,don't overthink it.

I can't tell you how much advancement I got exactly, something like 5 mm.I went in for a mild deficiency, so my surgeon didn't want to overdo it, and I trust him.I'm French,living in Paris, and choosing him was a no brainer since he's the go to surgeon for orthognatic surgery in France.He's a great professional and went conservative with me, but I'm a f**king perfectionist and feel I lack something like 3 mm.Maybe I get it wrong,but your overall advancement is close to 12 mm? Are you happy now?

I'm early post op, 5 weeks, but already regained full sensation and had unusually little swelling,so I guess I'm very close to final results.
If curious, I can send you pics in pm.

[asphyxia]

Oh, and just to answer about plate removal, someone here had it done one year after surgery or so for some muscle problem (it was sort or tangled in it if I recall) and it slightly reduced the projection (she sent pictures), not by resorption, but mechanically.

Voilà.

[needadvancement]

Does plate/screw removal require general anesthetic?

[asphyxia]

Not always, it can be done under twilight,depending on your surgeon .

[ForeverDet]

Hello,

I have a few questions regarding sliding genioplasty.

Here is my story:

Seeking to increase horizontal projection on my recessed chin (lack of projection), I opted into having a sliding genioplasty back in 2014; the results, however, did not meet my expectations, as my chin still appeared recessed. Apparently there was relapse during the first few weeks of recovery (total advancement was ~8mm). Steel wires utilized to secure the bone back together (no titanium plate).

Wanting to fix this, I had my second surgery around 3.5 months later. The second surgeon told me I was advanced around ~4mm (so this does indeed imply there was some sort of relapse). He removed the steel wires, retraced the initial cut, and advanced my chin around ~7-8mm. This time, a titanium plate was used for fixation. I don't think there was any relapse this time.

My questions are as follows:

1. I am now around 1 year and 2 months post-op, and I'm having no real issues other than some mild tightness in my chin / lower gum area. There is also some mild pain in the surgical spot on occasion that comes and go randomly. Has anyone experienced either one of these symptoms this far out?

2. I strongly desire to remove this titanium plate sometime down the road, but I'm concerned my chin will relapse or go back to its original place without the plate holding it in place. Does anyone in particular have any information on chin stability without the plate? I would love to hear some stories about the removal of these plates.

3. Will strenuous activity this far out increase the likelihood of a relapse?

4. I'm aware that nonunion can be a complication; how likely is something like this to occur? Has this happened to anyone here? If so, what are some symptoms to be aware of? Other than x-rays, how can this be diagnosed?

Looking forward to your responses back.

Thanks in advance.

I had a sliding genio with 8-9mm advancement back in 2007. I double jaw surgery in 2013 where the plate/screws were removed (leaving my chin untouched).

To answer your questions...

1. I never experienced pain IIRC but partial numbnes on part of my lower lip and chin pad was present even years after surgery. This is semi-common side-effect even when the surgery is performed perfectly.

2. There should be no bony relapse of the chin itself if the bones have fully fused. Which takes a year usually. I got mine removed 6 years after but there are people that have had genio hardware and even hardware from double jaw surgery removed after just a year. I never heard of relapse happening from just plate removal if everything has fully healed. A radiograph can confirm whether your bones have fused.

3. No. Even getting hit hard on the chin won't make it relapse although I'm sure you can break your chin bone! Not sure if the plates being there would be protective or worsen the injury but the chin "moving back" in a recessed position after complete fusing isn't really possible. Your chin has been lengthened permanently.

4. I would think radiographs would be the only way to know for sure. It's not a likely scenario as long as fixation was done correctly.

[Antbee]

Oh, and just to answer about plate removal, someone here had it done one year after surgery or so for some muscle problem (it was sort or tangled in it if I recall) and it slightly reduced the projection (she sent pictures), not by resorption, but mechanically.

Voilà.

Hi yes that was me. To answer @improvedchin's questions- my chin appeared flatter after plate removal because the muscle was no longer tangled. Your bone in your chin should be solid by now. I've never heard of chin release after the bone is set.... I understood true relapse only happen in the jaw positioning due to the joints moving around post-op. I don't believe physical activity is going to affect your chin at this stage. Your chin feels tight and strange (as does mine) most likely due to all the scar tissue from repeated surgeries. I'm due to have my genio re done in ten days as my chin is too large still and the muscle is pulling.

[needadvancement]

I do wonder if the screws and plates have any effect on contact sports. When I play rugby I get shoulder blasted on the chin sometimes and it can be quite hard. With the screws in there there isn't a risk of bone damage is there? Will also be asking this at my first consultation soon.

[ForeverDet]

Hi yes that was me. To answer @improvedchin's questions- my chin appeared flatter after plate removal because the muscle was no longer tangled. Your bone in your chin should be solid by now. I've never heard of chin release after the bone is set.... I understood true relapse only happen in the jaw positioning due to the joints moving around post-op. I don't believe physical activity is going to affect your chin at this stage. Your chin feels tight and strange (as does mine) most likely due to all the scar tissue from repeated surgeries. I'm due to have my genio re done in ten days as my chin is too large still and the muscle is pulling.

hey keep us updated! The genio is suppose to improve your lower lip too right? to cover more of your bottom teeth? I have the same "issue" and Dr. G did my surgery (altho he removed the hardware from the old genio I had and left my chin as is) but I don't think I'll get anything done about it. My lower lip didn't cover enough bottom teeth pre-surgery and still doesn't but the posture is normal.

[improvedchin]

I had a sliding genio with 8-9mm advancement back in 2007. I double jaw surgery in 2013 where the plate/screws were removed (leaving my chin untouched).

To answer your questions...

1. I never experienced pain IIRC but partial numbnes on part of my lower lip and chin pad was present even years after surgery. This is semi-common side-effect even when the surgery is performed perfectly.

2. There should be no bony relapse of the chin itself if the bones have fully fused. Which takes a year usually. I got mine removed 6 years after but there are people that have had genio hardware and even hardware from double jaw surgery removed after just a year. I never heard of relapse happening from just plate removal if everything has fully healed. A radiograph can confirm whether your bones have fused.

3. No. Even getting hit hard on the chin won't make it relapse although I'm sure you can break your chin bone! Not sure if the plates being there would be protective or worsen the injury but the chin "moving back" in a recessed position after complete fusing isn't really possible. Your chin has been lengthened permanently.

4. I would think radiographs would be the only way to know for sure. It's not a likely scenario as long as fixation was done correctly.

Hi! Thanks for the reply back! Well the physical activity I do is sort of gymnastics related, so it involves going upside down a lot, and often times this tightens my neck and such. But it sounds like once the bones have fused together, the soft tissue can't really push the chin back even the slightest bit correct?

For my second genio, my surgeon retraced the original cut, advanced the cut segment and plated everything together; from my understanding, he did not save the edges of the bone segment. Is it true that these edges must be shaved down in order for nonunion to be prevented?

By the way, how was recovery after plate removal compared to your actual sliding genioplasty? Did you ever experience any clicking noises or anything that resembled the sound of bones rubbing against each other after surgery? I did early on, but I believe it all went away over time.

Hi yes that was me. To answer @improvedchin's questions- my chin appeared flatter after plate removal because the muscle was no longer tangled. Your bone in your chin should be solid by now. I've never heard of chin release after the bone is set.... I understood true relapse only happen in the jaw positioning due to the joints moving around post-op. I don't believe physical activity is going to affect your chin at this stage. Your chin feels tight and strange (as does mine) most likely due to all the scar tissue from repeated surgeries. I'm due to have my genio re done in ten days as my chin is too large still and the muscle is pulling.

Hi there, thanks for the response back! So basically the tangled mucles were what provided additional projection prior to plate removal correct? Meaning, the reason your chin looked flatter wasn't because the bone relapsed back?

So this will be your third chin surgery correct?

As mentioned above, for my second genio, my surgeon retraced the original cut, advanced the cut segment and plated everything together; from my understanding, he did not save the edges of the bone segment. Is it true that these edges must be shaved down in order for nonunion to be prevented?

I feel very very mild pain time to time; the kind of pain that really doesn't affect me whatsoever. Does this ever happen to you as well? How about the noises I mentioned above?

Good luck on your surgery!

And thanks all for your informative responses!