Where to position osteotomies in genioglossal advancement surgery based on locations of the mental foramen, canine, lateral incisor, central incisor, and genial tubercle

Abstract

A straight line estimating the mental foramen, canine, lateral incisor, and central incisor tooth roots crosses at a mean of 22.3-22.6 mm above the inferior border of the mandible at the midline and has an angle of decline of about 18°. Potential osteotomies made parallel to and below this line result in tradeoffs between maximizing capture of the genioglossus muscle attachment and risk of dental/neurovascular injury.

What is the angular accuracy of regional voxel-based registration for segmental Le Fort I and genioplasty osteotomies?

“…A potential limitation of this study is that it did not account for variability of osteotomy design. For example, variations of the horizontal mandibular osteotomy that extend superiorly 33 to capture the genial tubercle or to mitigate unwanted mentolabial changes 34 would produce larger ROI, and could potentially have greater angular accuracy than was found in the present study. Indeed, the typical genioplasty segment from horizontal mandibular osteotomies consists mostly of cortical bone with a largely homogeneous radiodensity, potentially making R-VBR less accurate, as was found in proximal mandibular segments in sagittal split osteotomies 30 .…”

Mandibular muscle attachments in genial advancement surgery for obstructive sleep apnea

“…Additionally, in our dissections, the muscle attachments were often found extending onto the apex of the tubercles; however, they do not always originate or center on the apex, and the muscles fan out well beyond the tubercle with significant ranges ( P < .0001). Park et al used cone‐beam CT to analyze 33 patients undergoing surgery for OSA and proposed a potential osteotomy design for genioglossal advancement based on locations of the mental foramen, canine, central and lateral incisor tooth roots, and genial tubercle in relation to the IMB . This study evaluated the tradeoff between maximizing genioglossal muscle capture and the risk for dental and neurovascular injury when performing osteotomies for genioglossus advancement, thus highlighting the importance of adequate understanding of tubercle, muscle, and tooth‐root anatomy when designing ideal osteotomy placement for genioglossal advancement.…”

“…Our study cohort was limited in that we did not determine the distance of the tooth roots or intramandibular neurovascular structures from the tubercle or the muscles directly; however, when looking at a different cohort and comparing it with the data presented in this study, a much more clear picture of the close proximity of these important structures as they relate to anterior sleep mandibular osteotomies can be obtained. Further studies will examine the relationship between the superior border of genioglossus attachment, the tubercle, and the inferior apices of the tooth roots with their supportive neurovascular relationships.…”

Morphometric aspects and proposal of a new classification of genial tubercles in cone-beam computed tomography in a Brazilian population

“…In addition, the GT position has been used in surgical planning for maxillomandibular repositioning, especially in mandibular advancement for the treatment of obstructive sleep apnea syndrome (OSAS). 7 …”