- Email: [email protected]
Mini wing osteotomy: A variant of chin wing osteotomy
Journal Pre-proof Mini Wing osteotomy: a variant of Chin Wing osteotomy G. Cordier MD N. Sigaux MD MSc A. Carlier MD B. Ibrahim MD P. Cresseaux MD
PII:
S2468-7855(19)30255-1
DOI:
https://doi.org/doi:10.1016/j.jormas.2019.10.010
Reference:
JORMAS 763
To appear in:
Journal of Stomatology oral and Maxillofacial Surgery
Received Date:
18 September 2019
Accepted Date:
22 October 2019
Please cite this article as: Cordier G, Sigaux N, Carlier A, Ibrahim B, Cresseaux P, Mini Wing osteotomy: a variant of Chin Wing osteotomy, Journal of Stomatology oral and Maxillofacial Surgery (2019), doi: https://doi.org/10.1016/j.jormas.2019.10.010
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Published by Elsevier.
Mini Wing osteotomy : a variant of Chin Wing osteotomy G. Cordier1, N. Sigaux1, A. Carlier1, B. Ibrahim, P1. Cresseaux2 CORDIER Guillaume
MD
[email protected] SIGAUX Nicolas
MD, MSc
[email protected] CARLIER Adélaïde
MD
IBRAHIM Badr
oo f
[email protected] MD
[email protected] MD
pr
CRESSEAUX Paul [email protected] 1
e-
Department of Maxillofacial and Facial Plastic Surgery, Lyon Sud Hospital,
2
Hôpital Privé Jean Mermoz, Lyon
Paul CRESSEAUX
Jo ur n
[email protected]
al
Corresponding author :
Pr
Hospices Civils de Lyon, Claude Bernard Lyon 1 University
Abstract
The Mini Wing is a variant of the Chin Wing osteotomy. Its design extends from the chin region to the horizontal branch of the mandible as in a traditional Chin Wing. However, the posterior most cut ends on the upper part of the mandibular notch. It corresponds to a shortened Chin Wing that respects the basilar edge of the mandible. Its advantage is the capacity to associate it with a bilateral sagittal split osteotomy (BSSO) in the global management of dento-skeletal deformity. There is no contraindication to the realization of a Mini Wing. Contrarily to the traditional Chin Wing, a very low positioned inferior alveolar nerve (IAN) is not a contraindication to the Mini Wing. Keys Words Mini Wing, Chin Wing, Genioplasty, orthognathic surgery, Chin
Page 1 of 13
Page 2 of 13
al
Jo ur n oo f
pr
e-
Pr
Introduction The Chin Wing is a genioplasty procedure where the osteotomy is extended posteriorly to the mandibular angles. The technique was initially described by Triaca et al(1,2) to correct and lower the mandibular angles. It was further developed by Cresseaux et al(3). In this technique, the basilar edge is considered as a whole anatomical unit to obtain a better functional and aesthetic result. The assets of the Chin Wing are two fold : 1) improve the volume gain of the lower third of the face 2) provide soft tissue support that greatly improve labial competence. However the association of the Chin Wing with a bilateral sagittal split osteotomy (BSSO) is complicated. In addition, for some patients, the realization of a Chin Wing is impossible given a very
oo f
low position of the inferior alveolar nerve (IAN).
We therefore propose a modified Chin Wing technique that adresses the shortfalls of the traditional Chin Wing: the Mini Wing. It is a shorter osteotomy of the basilar edge of the mandible which can
pr
easily be combined to BSSO. Moreverover, it has no contraindications related to the position of the
e-
IAN. Technical note
Pr
Preoperative evaluation includes pictures of the patient, standard radiographs (frontal cephalogram, lateral cephalogram, and panoramic radiograph) and Cone Beam CT (CBCT).
al
The procedure is performed under general anaesthesia in supine position. Nasotracheal intubation is performed to control the occlusion intraoperatively. The sub-periosteal plane is infiltrated with a 1%
Jo ur n
adrenaline solution.
The oral incision is made in the vestibule from tooth 36 to 46 with a monopolar cautery. Care is taken to leave a few millimeters of free mucosa between the junction of the attached gingiva and the site of incision to facilitate closure. A less invasive approach has been previsoulsy described and can be achieved with three incisions(4). A sub-periosteal dissection is performed. The dissection is extended to the vestibular cortex of the entire mandibular body with the exception of the basilar border in order not to compromise the vascularization of the Wing. The mental nerves are identified and dissected with care. The sub-periosteal dissection is performed about 5 to 6 mm below the foramina. The osteotomy starts on the midline. A round bur is used only for the external cortex of the symphysis. The piezotome is then angled obliquely to continue the deep osteotomy and cut towards lingual cortex. The piezotome limits the risk of bleeding from the floor of the mouth. In a frontal view, the symphysis osteotomy line forms a flattened inverted V (Fig 1) ending under the mental
Page 3 of 13
foramen on each side (usually 3 mm below the foramina as dictated by the analysis of the preoperative Cone Beam scan). The posterior parts of the osteotomy, behind the mental foramen, is performed with the piezotome along a path parallel to the occlusal plane. The lingual cortex is cut obliquely following a downward and internally slanting plane of orientation in order to reach the lingual cortex at a lower height than the level at which the vestibular cortex was cut. This orientation of the piezotome is an essential precaution to avoid damage to the inferior alveolar nerve. Unlike Triaca’s Chin Wing, which prolongs the osteotomy horizontally to the angles, the Mini Wing interrupts the osteotomy at the top of the basilar notch (Fig 2). The horizontal part of the Mini Wing includes all the basilar part of the horizontal branch, sparing only the mandibular angle.
oo f
The complete splitting is then finalized with an osteotome placed under the mental foramen. Osteosynthesis is performed with a X-shaped plate on the symphysis with a preformed step (size of the step is up to 10 or 12 mm). The posterior fragments, at the level of the notch, will be maintained
pr
in final position either by a plate (Fig 4) or by bank bone. It is important to maintain the posterior height because the fragment of Mini Wing will tend to perform a clockwise rotation by the anterior
e-
traction of the suprahyoid muscles.
In its final position the Mini Wing will not have any bony contact with the rest of the mandible. It will
Pr
therefore be essential to perform a graft of bone substitutes. (Fig 2) A careful and hermetic suture is of paramount importance to mitigate the risk of infection associated
al
to the presence of the graft. The closure is made with a continuous stitch of absorbable monofilament suture with a vascular needle.
Jo ur n
Discussion
The Mini Wing has many advantages over conventional genioplasty and is a less restrictive option than the Chin Wing.
The main indication of the Mini Wing is retrogenia. It can be used for all conventional genioplasty movements except for pure height reduction. Indeed, too much bone would need to be resected to achieve that specific goal. The advantage of Mini Wing over the Chin Wing lies in its ability associate any type of classical BSSO (Epker(5) or Obwegeser osteotomy(6)), in the setting of orthodontic-surgical protocols (Fig 3). On the contrary, the Chin Wing’s extension to the angles requires a modification of the BSSO(7) or the use of a high oblique osteotomy as described by Kater and Paulus(8).
Page 4 of 13
There are no contraindications to the Mini Wing. Unlike in the Chin Wing procedure, the position of the inferior alveolar nerve is not a limiting factor to performing a Mini Wing (Fig 5). The osteotomy line starting 3 mm below the mental foramen and following a path parallel to the occlusal plane up to the notch while orienting the plane of section obliquely and down avoids any risk of nerve damage. The Mini Wing respects the basilar border of the mandible as an anatomical unit. Thus, unlike a genioplasty, the osteotomy line will not create a notch at the level of the basilar edge . Furthermore, the Mini Wing allows for the decrease of a prominent pre-existing mandibular notch by lowering the distal fragment and grafting the gap.
oo f
The conventional advancement genioplasty tends to cause a slight loss of height. This is due to the orientation of its osteotomy line. It is particularly problematic in cases where a large correction is needed. Genioplasty tends to decrease the symphyseal height the more the osteotomized segment is
pr
advanced forward. This leads to an increasing lack of soft tissue support and overall poor results. In contrast, the Mini Wing will be able to advance without loss of height since it is free of bony
e-
contacts. Hence it can easily be positioned at an optimal anterior and veritcal position. In addition, the advancement can be much bigger than in a conventional genioplasty (up to 12mm). It is however
Pr
necessary in our technique to graft using osteoconductive biomaterials. The major advantage of the Mini Wing is its significant overall effect on the soft tissues of the lower third of the face. The mandible being shaped like a horseshoe, its width is greater at the level of
al
molars than canines. Thus, the Mini Wing propulsion movement brings a larger basilar fragment
Jo ur n
forward. (Fig 2) This bony contribution exerts a tension on all the soft tissues and particularly those of the lateral inferior part of the face. On the contrary, classical genioplasty mobilizes only the soft tissues of the chin region.
The Mini Wing is a simpler and faster intervention than the Chin Wing. There is no risk of bone resorption. Indeed, the Mini Wing retains a large periosteal vascularization unlike the distal fragments of the Chin Wing.
On the other hand, the isolated Mini Wing will not allow a lowering of the mandibular angles. Nevertheless, in cases of orthodontic surgical protcols, the lowering of the angles can be achieved by a modified BSSO associated to the Mini Wing. The Mini Wing is a little more technically challenging than a classic genioplasty. However, in our experience it does not increase surgical complications compared to a conventional genioplasty. It increases surgical time and requires a larger intra-oral incision in order to better control the distal
Page 5 of 13
part of the osteotomy and safely guide it away from the nerve. A prosepctive clinical trial is underway to study the Mini Wing’s impact on the inferior alvolar nerve function and its long-term stability. To summarize, the Mini Wing can be offered in most cases where a classic genioplasty would be indicated and specially for large advancements. It may be used in combinaison with a BSSO in orthodontic-surgical protocols.
Disclosure of interest
Jo ur n
al
Pr
e-
pr
oo f
The authors declare that they have no competing interest.
Page 6 of 13
References
1.
Triaca A, Brusco D, Guijarro-Martínez R. Chin wing osteotomy for the correction of hyper-
divergent skeletal class III deformity: technical modification. Br J Oral Maxillofac Surg. 2015;53:775– 7. 2.
Triaca A, Minoretti R, Saulacic N. Mandibula wing osteotomy for correction of the
mandibular plane: A case report. Br J Oral Maxillofac Surg. 2010;48:182–4. Pouzoulet P, Cheynet F, Guyot L, Foletti JM, Chossegros C, Cresseaux P. Chin wing: Technical
note. J Stomatol Oral Maxillofac Surg. 2018;119:315–8. 4.
oo f
3.
Lopez PE, Guerrero CA, Mujica EV. Mandibular basal osteotomy: new designs and fixation
5.
pr
techniques. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg. 2011;69:786–97. Epker BN. Modifications in the sagittal osteotomy of the mandible. J Oral Surg Am Dent
6.
e-
Assoc 1965. 1977;35:157–9.
Obwegeser HL. Orthognathic Surgery and a Tale of How Three Procedures Came to Be: A
7.
Pr
Letter to the Next Generations of Surgeons. Clin Plast Surg. 2007;34:331–55. Cordier G, Sigaux N, Ibrahim B, Cresseaux P. The intermediate length BSSO: finding the
balance between the classical and short designs. J Stomatol Oral Maxillofac Surg. 2019: (article in
Paulus C, Kater W. [High oblique sagittal split osteotomy]. Rev Stomatol Chir Maxillo-Faciale
Jo ur n
8.
al
press)
Chir Orale. 2013;114:166–9.
Page 7 of 13
oo f
Figures
Jo ur n
al
Pr
e-
pr
Figure 1 : Mini Wing osteotomy
Page 8 of 13
Figure 2 : Cone Beam postoperative, Mini Wing + Le Fort (Bottom view, lateral view and front view)
Jo ur n
al
Pr
e-
pr
oo f
Figure 2 : Cone Beam postoperative, Mini Wing + Le Fort (Bottom view, lateral view and front view)
Page 9 of 13
oo f
Jo ur n
al
Pr
e-
pr
Figure 3 : Mini Wing + BSSO, post operative Cone Beam
Page 10 of 13
oo f pr
e-
Figure 4 : Mini Wing + BSSO, intraoperative view with contention plate positioning at the premolar
Jo ur n
al
Pr
level.
Page 11 of 13
oo f
Figure 5 : Position of inferior alveolar nerve (red dots), Chin Wing osteotomy (yellow line), Mini Wing
Jo ur n
al
Pr
e-
pr
osteotomy (blue line).
Page 12 of 13
oo f pr ePr
Jo ur n
al
Figure 6 : Mini Wing + BSSO, pre-operative (top) and post-operative (bottom) pictures
Page 13 of 13
PII:
S2468-7855(19)30255-1
DOI:
https://doi.org/doi:10.1016/j.jormas.2019.10.010
Reference:
JORMAS 763
To appear in:
Journal of Stomatology oral and Maxillofacial Surgery
Received Date:
18 September 2019
Accepted Date:
22 October 2019
Please cite this article as: Cordier G, Sigaux N, Carlier A, Ibrahim B, Cresseaux P, Mini Wing osteotomy: a variant of Chin Wing osteotomy, Journal of Stomatology oral and Maxillofacial Surgery (2019), doi: https://doi.org/10.1016/j.jormas.2019.10.010
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Published by Elsevier.
Mini Wing osteotomy : a variant of Chin Wing osteotomy G. Cordier1, N. Sigaux1, A. Carlier1, B. Ibrahim, P1. Cresseaux2 CORDIER Guillaume
MD
[email protected] SIGAUX Nicolas
MD, MSc
[email protected] CARLIER Adélaïde
MD
IBRAHIM Badr
oo f
[email protected] MD
[email protected] MD
pr
CRESSEAUX Paul [email protected] 1
e-
Department of Maxillofacial and Facial Plastic Surgery, Lyon Sud Hospital,
2
Hôpital Privé Jean Mermoz, Lyon
Paul CRESSEAUX
Jo ur n
[email protected]
al
Corresponding author :
Pr
Hospices Civils de Lyon, Claude Bernard Lyon 1 University
Abstract
The Mini Wing is a variant of the Chin Wing osteotomy. Its design extends from the chin region to the horizontal branch of the mandible as in a traditional Chin Wing. However, the posterior most cut ends on the upper part of the mandibular notch. It corresponds to a shortened Chin Wing that respects the basilar edge of the mandible. Its advantage is the capacity to associate it with a bilateral sagittal split osteotomy (BSSO) in the global management of dento-skeletal deformity. There is no contraindication to the realization of a Mini Wing. Contrarily to the traditional Chin Wing, a very low positioned inferior alveolar nerve (IAN) is not a contraindication to the Mini Wing. Keys Words Mini Wing, Chin Wing, Genioplasty, orthognathic surgery, Chin
Page 1 of 13
Page 2 of 13
al
Jo ur n oo f
pr
e-
Pr
Introduction The Chin Wing is a genioplasty procedure where the osteotomy is extended posteriorly to the mandibular angles. The technique was initially described by Triaca et al(1,2) to correct and lower the mandibular angles. It was further developed by Cresseaux et al(3). In this technique, the basilar edge is considered as a whole anatomical unit to obtain a better functional and aesthetic result. The assets of the Chin Wing are two fold : 1) improve the volume gain of the lower third of the face 2) provide soft tissue support that greatly improve labial competence. However the association of the Chin Wing with a bilateral sagittal split osteotomy (BSSO) is complicated. In addition, for some patients, the realization of a Chin Wing is impossible given a very
oo f
low position of the inferior alveolar nerve (IAN).
We therefore propose a modified Chin Wing technique that adresses the shortfalls of the traditional Chin Wing: the Mini Wing. It is a shorter osteotomy of the basilar edge of the mandible which can
pr
easily be combined to BSSO. Moreverover, it has no contraindications related to the position of the
e-
IAN. Technical note
Pr
Preoperative evaluation includes pictures of the patient, standard radiographs (frontal cephalogram, lateral cephalogram, and panoramic radiograph) and Cone Beam CT (CBCT).
al
The procedure is performed under general anaesthesia in supine position. Nasotracheal intubation is performed to control the occlusion intraoperatively. The sub-periosteal plane is infiltrated with a 1%
Jo ur n
adrenaline solution.
The oral incision is made in the vestibule from tooth 36 to 46 with a monopolar cautery. Care is taken to leave a few millimeters of free mucosa between the junction of the attached gingiva and the site of incision to facilitate closure. A less invasive approach has been previsoulsy described and can be achieved with three incisions(4). A sub-periosteal dissection is performed. The dissection is extended to the vestibular cortex of the entire mandibular body with the exception of the basilar border in order not to compromise the vascularization of the Wing. The mental nerves are identified and dissected with care. The sub-periosteal dissection is performed about 5 to 6 mm below the foramina. The osteotomy starts on the midline. A round bur is used only for the external cortex of the symphysis. The piezotome is then angled obliquely to continue the deep osteotomy and cut towards lingual cortex. The piezotome limits the risk of bleeding from the floor of the mouth. In a frontal view, the symphysis osteotomy line forms a flattened inverted V (Fig 1) ending under the mental
Page 3 of 13
foramen on each side (usually 3 mm below the foramina as dictated by the analysis of the preoperative Cone Beam scan). The posterior parts of the osteotomy, behind the mental foramen, is performed with the piezotome along a path parallel to the occlusal plane. The lingual cortex is cut obliquely following a downward and internally slanting plane of orientation in order to reach the lingual cortex at a lower height than the level at which the vestibular cortex was cut. This orientation of the piezotome is an essential precaution to avoid damage to the inferior alveolar nerve. Unlike Triaca’s Chin Wing, which prolongs the osteotomy horizontally to the angles, the Mini Wing interrupts the osteotomy at the top of the basilar notch (Fig 2). The horizontal part of the Mini Wing includes all the basilar part of the horizontal branch, sparing only the mandibular angle.
oo f
The complete splitting is then finalized with an osteotome placed under the mental foramen. Osteosynthesis is performed with a X-shaped plate on the symphysis with a preformed step (size of the step is up to 10 or 12 mm). The posterior fragments, at the level of the notch, will be maintained
pr
in final position either by a plate (Fig 4) or by bank bone. It is important to maintain the posterior height because the fragment of Mini Wing will tend to perform a clockwise rotation by the anterior
e-
traction of the suprahyoid muscles.
In its final position the Mini Wing will not have any bony contact with the rest of the mandible. It will
Pr
therefore be essential to perform a graft of bone substitutes. (Fig 2) A careful and hermetic suture is of paramount importance to mitigate the risk of infection associated
al
to the presence of the graft. The closure is made with a continuous stitch of absorbable monofilament suture with a vascular needle.
Jo ur n
Discussion
The Mini Wing has many advantages over conventional genioplasty and is a less restrictive option than the Chin Wing.
The main indication of the Mini Wing is retrogenia. It can be used for all conventional genioplasty movements except for pure height reduction. Indeed, too much bone would need to be resected to achieve that specific goal. The advantage of Mini Wing over the Chin Wing lies in its ability associate any type of classical BSSO (Epker(5) or Obwegeser osteotomy(6)), in the setting of orthodontic-surgical protocols (Fig 3). On the contrary, the Chin Wing’s extension to the angles requires a modification of the BSSO(7) or the use of a high oblique osteotomy as described by Kater and Paulus(8).
Page 4 of 13
There are no contraindications to the Mini Wing. Unlike in the Chin Wing procedure, the position of the inferior alveolar nerve is not a limiting factor to performing a Mini Wing (Fig 5). The osteotomy line starting 3 mm below the mental foramen and following a path parallel to the occlusal plane up to the notch while orienting the plane of section obliquely and down avoids any risk of nerve damage. The Mini Wing respects the basilar border of the mandible as an anatomical unit. Thus, unlike a genioplasty, the osteotomy line will not create a notch at the level of the basilar edge . Furthermore, the Mini Wing allows for the decrease of a prominent pre-existing mandibular notch by lowering the distal fragment and grafting the gap.
oo f
The conventional advancement genioplasty tends to cause a slight loss of height. This is due to the orientation of its osteotomy line. It is particularly problematic in cases where a large correction is needed. Genioplasty tends to decrease the symphyseal height the more the osteotomized segment is
pr
advanced forward. This leads to an increasing lack of soft tissue support and overall poor results. In contrast, the Mini Wing will be able to advance without loss of height since it is free of bony
e-
contacts. Hence it can easily be positioned at an optimal anterior and veritcal position. In addition, the advancement can be much bigger than in a conventional genioplasty (up to 12mm). It is however
Pr
necessary in our technique to graft using osteoconductive biomaterials. The major advantage of the Mini Wing is its significant overall effect on the soft tissues of the lower third of the face. The mandible being shaped like a horseshoe, its width is greater at the level of
al
molars than canines. Thus, the Mini Wing propulsion movement brings a larger basilar fragment
Jo ur n
forward. (Fig 2) This bony contribution exerts a tension on all the soft tissues and particularly those of the lateral inferior part of the face. On the contrary, classical genioplasty mobilizes only the soft tissues of the chin region.
The Mini Wing is a simpler and faster intervention than the Chin Wing. There is no risk of bone resorption. Indeed, the Mini Wing retains a large periosteal vascularization unlike the distal fragments of the Chin Wing.
On the other hand, the isolated Mini Wing will not allow a lowering of the mandibular angles. Nevertheless, in cases of orthodontic surgical protcols, the lowering of the angles can be achieved by a modified BSSO associated to the Mini Wing. The Mini Wing is a little more technically challenging than a classic genioplasty. However, in our experience it does not increase surgical complications compared to a conventional genioplasty. It increases surgical time and requires a larger intra-oral incision in order to better control the distal
Page 5 of 13
part of the osteotomy and safely guide it away from the nerve. A prosepctive clinical trial is underway to study the Mini Wing’s impact on the inferior alvolar nerve function and its long-term stability. To summarize, the Mini Wing can be offered in most cases where a classic genioplasty would be indicated and specially for large advancements. It may be used in combinaison with a BSSO in orthodontic-surgical protocols.
Disclosure of interest
Jo ur n
al
Pr
e-
pr
oo f
The authors declare that they have no competing interest.
Page 6 of 13
References
1.
Triaca A, Brusco D, Guijarro-Martínez R. Chin wing osteotomy for the correction of hyper-
divergent skeletal class III deformity: technical modification. Br J Oral Maxillofac Surg. 2015;53:775– 7. 2.
Triaca A, Minoretti R, Saulacic N. Mandibula wing osteotomy for correction of the
mandibular plane: A case report. Br J Oral Maxillofac Surg. 2010;48:182–4. Pouzoulet P, Cheynet F, Guyot L, Foletti JM, Chossegros C, Cresseaux P. Chin wing: Technical
note. J Stomatol Oral Maxillofac Surg. 2018;119:315–8. 4.
oo f
3.
Lopez PE, Guerrero CA, Mujica EV. Mandibular basal osteotomy: new designs and fixation
5.
pr
techniques. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg. 2011;69:786–97. Epker BN. Modifications in the sagittal osteotomy of the mandible. J Oral Surg Am Dent
6.
e-
Assoc 1965. 1977;35:157–9.
Obwegeser HL. Orthognathic Surgery and a Tale of How Three Procedures Came to Be: A
7.
Pr
Letter to the Next Generations of Surgeons. Clin Plast Surg. 2007;34:331–55. Cordier G, Sigaux N, Ibrahim B, Cresseaux P. The intermediate length BSSO: finding the
balance between the classical and short designs. J Stomatol Oral Maxillofac Surg. 2019: (article in
Paulus C, Kater W. [High oblique sagittal split osteotomy]. Rev Stomatol Chir Maxillo-Faciale
Jo ur n
8.
al
press)
Chir Orale. 2013;114:166–9.
Page 7 of 13
oo f
Figures
Jo ur n
al
Pr
e-
pr
Figure 1 : Mini Wing osteotomy
Page 8 of 13
Figure 2 : Cone Beam postoperative, Mini Wing + Le Fort (Bottom view, lateral view and front view)
Jo ur n
al
Pr
e-
pr
oo f
Figure 2 : Cone Beam postoperative, Mini Wing + Le Fort (Bottom view, lateral view and front view)
Page 9 of 13
oo f
Jo ur n
al
Pr
e-
pr
Figure 3 : Mini Wing + BSSO, post operative Cone Beam
Page 10 of 13
oo f pr
e-
Figure 4 : Mini Wing + BSSO, intraoperative view with contention plate positioning at the premolar
Jo ur n
al
Pr
level.
Page 11 of 13
oo f
Figure 5 : Position of inferior alveolar nerve (red dots), Chin Wing osteotomy (yellow line), Mini Wing
Jo ur n
al
Pr
e-
pr
osteotomy (blue line).
Page 12 of 13
oo f pr ePr
Jo ur n
al
Figure 6 : Mini Wing + BSSO, pre-operative (top) and post-operative (bottom) pictures
Page 13 of 13