Abstract

RAMIREZ, O. M.; WERTMULLER, V. S.  and  NOVO TORRES, A.. Facial beauty "mandibular matrix implant system": endoscopic access. Cir. plást. iberolatinoam. [online]. 2007, vol.33, n.3, pp.143-153. ISSN 1989-2055.

One of the most frequent aesthetic problems and of a difficult correction that affects the lower third of the face is the disharmony between the soft tissues and the underlying skeletal support. A loss of volume or a genetically small mandible affects the aesthetics and function of the mouth, chin, and neck. The limitations of the conventional techniques and the limited aesthetic results obtained with those motivated the author to develop a system of implants and a technique of three-dimensional remodeling of the mandible. This system is called Mandibular Matrix Implant System. The Mandibular Matrix Implant System consists of several units, an articulated wraparound geniomandibular implant and two wraparound gonial angle implants, one for each side. A prejowl implant can be integrated in the system as an additional implant as overlay or as a replacement for the chin implant. The implants are made of biocompatible high density porous polyethylene that allows his reshaping and adaptation to the aesthetic needs of every patient. In addition they assemble perfectly to the bony surface of the mandible. It is indicated primarily for the beautification of the facial framework. It can be performed as a separated procedure or in combination with a facial rejuvenation. It is also used in edentulous patients or in those with micrognatia. The surgical access is through a small submental incision that allows a wide subperiosteal dissection, and introduction of each of the components of the matrix system under endoscopic assistance. The final selection of size, projection and outline of the implants is decided after placing specially made silicone sizors. These serve as test-implants to help carve the permanent implants. The gonial angle implants are fixated in place first. This is done with sutures that holds the implants against small bone tunnels made on the border of the mandible in front of the anterior border of the implant. Each half of the geniomandibular implant is stabilized with a titanium screw. The superposition of the chin implant over the gonial angle is another additional stabilizing element. The pterigo-masseteric sling help to provide additional stabilization to the gonial implant. The endoscopic technique for the Mandibular Matrix Implant System has been used in over 100 patients. Compared with the open technique published in the year 2000 this approach is superior in terms of risk of infection. Otherwise the rest of the positive effects of the Matrix System particularly the aesthetic results are reemphasized in this review.

Keywords : Aesthetic facial surgery; Remodeling mandible surgery; Endoscopic surgery.

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