CPT® Code 21123

1. Indications

Genioplasty with sliding osteotomy and augmentation using interpositional bone grafts is indicated for patients presenting with specific conditions related to the bony contour of the chin. The following indications are explicitly recognized for this procedure:

• Receding Chin Patients with a receding chin may seek this procedure to enhance facial balance and improve aesthetic appearance.
• Protruding Chin Individuals with a protruding chin can benefit from this surgery to achieve a more harmonious facial profile.
• Asymmetrical Chin Patients with asymmetrical chin contours may require this procedure to correct the imbalance and achieve symmetry.
• Bone Defects The procedure is also indicated for correcting bone defects in the chin area, which may arise from trauma or congenital conditions.

2. Procedure

The procedure for genioplasty with sliding osteotomy and augmentation using interpositional bone grafts involves several detailed steps, each critical to the overall success of the surgery:

• Step 1: Incision and Exposure The procedure begins with an incision made in the gingivolabial sulcus, allowing access to the underlying bone. The periosteum is then exposed through a careful subperiosteal dissection, which is performed laterally from the midline until the mental nerves are identified. This step is essential to avoid nerve damage during the surgery.
• Step 2: Bone Cuts After the surgical site is prepared, the surgeon determines the placement of the bone cuts necessary for the sliding osteotomy. Using a sagittal saw, the mandible is cut on each side, which allows for the repositioning of the chin. The specific placement of these cuts is crucial for achieving the desired chin contour.
• Step 3: Chin Advancement or Retraction Depending on the patient's specific needs, the chin is either advanced or retruded. This adjustment is made to correct the bony contour and improve facial aesthetics.
• Step 4: Bone Grafting In this procedure, interpositional bone grafts are utilized. An autograft is harvested through a separate incision, and it is then configured to the desired size and shape. The graft is packed into the surgical defect created by the osteotomy, providing additional support and contour to the chin.
• Step 5: Securing the Bone Once the bone graft is in place, the chin is secured in the desired position using wires or a plate and screw device. This stabilization is vital for ensuring that the bone remains in the correct position during the healing process.
• Step 6: Closure Finally, the overlying soft tissues are closed in layers. This meticulous closure technique is important for promoting optimal healing and minimizing scarring.

3. Post-Procedure

Post-procedure care following genioplasty with sliding osteotomy and augmentation using interpositional bone grafts is essential for ensuring proper recovery. Patients can expect some swelling and discomfort in the chin area, which can be managed with prescribed pain medications. It is important for patients to follow their surgeon's instructions regarding activity restrictions, dietary modifications, and oral hygiene practices to prevent complications. Regular follow-up appointments will be necessary to monitor healing and assess the position of the chin and the stability of the bone grafts. Patients should be advised that full recovery may take several weeks, during which time they should avoid strenuous activities that could impact the surgical site.