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Online ISSN 1827-174X
D'Andrea F., Brongo S., Ferraro G., Di Nola G., Nicoletti G.
Background. Surgery to correct the facial profile is often not limited to correcting a hooked nose owing to the presence in many cases of hypoplasia of the mental symphysis, also known as microgenia. Only by resolving both these irregularities, it is possible to improve the profile with satisfactory cosmetic results.
Methods. 14 patients affected by microgenia who had undergone rhinoplastic surgery with additional mentoplasty, using different alloplastic materials, were examined in order to evaluate the differences in terms of cosmetic results, tolerability and resorption of under-lying bone. In the first group of 7 patients (4 females and 3 males), additional chin plastic surgery was performed using a soft prosthesis in solid silicone with a closed preshaped angle; in the second group of 7 patients (5 females and 2 males) we used preshaped chin prostheses in E-PTFE. The insertion of the prosthesis was performed in both groups under local anesthetic using an intra-oral surgical approach consisting of an incision above the vestibular groove with subsequent lifting of a suitably sized flap of mucoperiosteum. The degree of microgenia was determined during the preoperative evaluation using X-rays in various projections and photos. In the postoperative phase, all patients were monitored using clinical examinations, profilometric tests and X-rays during the 15-month follow-up.
Results. In view of the results obtained, we can affirm that both materials were valid aids for the correction of microgenia. The drawback of silicone is a reduced integration in the host tissues with a greater possibility of spontaneous or post-traumatic dislocation (1 case in our experience). This is coupled with a more marked sub-prosthetic bone resorption compared to prostheses in E-PTFE, as found in patients in the first group (10% on average) which in the long term might affect the outcome of the correction. On the contrary, prostheses in E-PTFE are made up of a material composed of extremely pure polytetrafluoroethylene whose structure, which is unique among the synthetic materials, allows collagen fibres and fibroblasts to penetrate the cells (cellular rehabitation), thus enabling E-PTFE to anchor to the surrounding tissues without being encapsulated.
Conclusions. For this reason, E-PTFE prostheses are completely inert, avoiding any rejection reaction; they are more stable, with less possibility of spontaneous or post-traumatic dislocation and also cause less subprosthetic bone resorption leading to more stable results over time.