Sliding Genioplasty

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Preoperative Considerations

Consent:

  • Loss of vestibular depth/scarring
  • Witch's chin deformity
  • Lip numbness
  • Asymmetry
  • Hardware failure/dehiscence

Anesthesia/Positioning:

  • Nasal tube preferred

Other:

  • Tooth borne cutting guide if possible

Armamentarium:

  • Monopolar/Bipolar Electrocautery
  • Local anesthesia
  • #15 blade
  • Surgical Scissor
  • Toe Out Retractors
  • Genioplasty Guide PRN
  • Reciprocating Saw
  • Bone Clamp
  • Drill
  • Plating kit
  • 3-0 Vicryl
  • 3-0 Chromic Gut

Technique

Postoperative Considerations

Immediate:

  • Compressive dressing 24hr

Follow Up:

  • None

Operative Note

Surgeon(s): ***

Assistant Surgeon(s):  ***

Preoperative Diagnosis: ***

Postoperative Diagnosis: Same

Procedure(s): Sliding Genioplasty

Anesthesia: General

Implants: ***

Specimen: None

Drains: None

Fluids: See anesthesia record

EBL: <50ml

Complications: None

Counts:  Correct x2

Indications: ​***

Findings: As expected

Procedure in Detail:

The patient was seen in the preoperative holding area with a H&P was updated, consents were verified, surgical site marked, and all questions and concerns related to the proposed procedure were discussed in detail.  The patient was transferred to the operating room by the anesthesia team.  The patient underwent general anesthesia with endotracheal intubation. Tegaderms were placed over the eyes. The patient was prepped and draped in the standard fashion for maxillofacial procedures.  A time-out was performed and the procedure began.

A anterior vestibular incision was made and tissues were dissected. The mentalis muscle was released to expose the underlying symphysis. A horizontal osteotomy was made using a reciprocating saw, and the anterior segment of the mandible was mobilized to the desired position. Careful attention was paid to preserve the integrity of the mental nerve during the osteotomy and mobilization. Once the desired advancement of the chin was achieved, the mobilized segment was secured in place using miniplates and screws. Hemostasis was ensured, and the wound was irrigated with saline solution. Closure was performed in layers using absorbable sutures to resuspend the mentalis then close the mucosa.

The patient's face was then cleaned and the posterior pharynx was suctioned. An OG tube was used to suction out the contents of the stomach. Tegaderms were removed from the eyes. Dressings were placed. The patient was then transferred back to the care of the anesthesia team for extubation and recovery.

Coding

CDT Codes:

  • D7820 - Genioplasty - Osseous
  • D7830 - Genioplasty - Implant
  • D7840 - Genioplasty - Other

CPT Codes:

  • 21120 - Genioplasty; sliding osteotomy, single piece
  • 21121 - Genioplasty; sliding osteotomy, segmental (eg, anterior and posterior segment)
  • 21122 - Genioplasty; sliding osteotomy, multiple piece (eg, anterior and bilateral posterior segments)
  • 21123 - Genioplasty; augmentation (eg, implant)
  • 21125 - Genioplasty; sliding osteotomy, augmentation (eg, implant and osteotomy)
  • 21127 - Genioplasty; sliding osteotomy, augmentation (eg, implant and osteotomy) requiring bone graft(s), with or without soft tissue recontouring
  • 21137 - Genioplasty; advancement, by osteotomy
  • 21138 - Genioplasty; advancement with simultaneous genioglossus advancement and hyoid myotomy, with or without soft tissue procedures (eg, genioplasty)
  • 21139 - Genioplasty; advancement, by osteotomy, requiring bone graft(s), with or without soft tissue recontouring
  • 21141 - Genioplasty; reduction by bone ostectomy or recontouring
  • 21142 - Genioplasty; augmentation by sliding osteotomy, single piece
  • 21143 - Genioplasty; augmentation by sliding osteotomy, segmental (eg, anterior and posterior segment)
  • 21145 - Genioplasty; augmentation by sliding osteotomy, multiple piece (eg, anterior and bilateral posterior segments)
  • 21146 - Genioplasty; augmentation by advancement, by osteotomy
  • 21147 - Genioplasty; augmentation by advancement, by osteotomy, requiring bone graft(s), with or without soft tissue recontouring
  • 21150 - Genioplasty; implant surgery