Plate Removal and Secondary Sliding Genioplasty Advancement
Q: Dr. Eppley, One year ago I had a sliding genioplasty (along with LeFort 1) that horizontally advanced my chin 6mm. Although the projection of my chin improved, I was still unsatisfied by it, so on Friday, I was scheduled to have another 6mm genioplasty (for more horizontal advancement), as well as wisdom teeth extracted. When my surgeon went in, he saw that the plate and screws from the first genioplasty were completely overgrown with bone so he opted to place a 5.5mm implant instead. Naturally I was very upset when I found out upon waking up. I’m 100% I’ll be removing the implant. In a case where the plate and screws are overgrown with bone, is it truly that risky to cut or drill through? Can a 4mm genioplasty at minimum possibly be done at the time of implant removal?
A: I can only speak from personal experience but I have yet to see a chin plate that could not be removed…and I have seen many with partial or near complete bony overgrowths. I more informed answer would require review of an x-ray that shows your plate and screws. Sometimes the screwheads are stripped and the shaft of the screw(s) can not be removed but the plate can always be with some bone drilling and effort. Once the plate is removed a secondary sliding genoplasty can be performed for an additional 4mm movement.
Dr. Barry Eppley