This paper describes a case of mental nerve neuralgia following a traumatic dislodgement of a chin implant ten months after surgery. Our case is unusual, both in the specific complication and the patients' atypical representation—delayed and initially without mention of trauma. To the authors' knowledge, this case has not been reported previously in the literature. We review the complications of chin augmentation and the techniques for fixation and discuss implications for the preoperative disclosure with patients.
Mental nerve injury can occur as a consequence of the various chin augmentation techniques to correct microgenia or “small chin.” The mental nerve is particularly vulnerable during more invasive procedures such as horizontal advancement osteotomy. Augmentation using an implant is considered to be a safer simpler procedure with fewer complications. Mental nerve injury occurs occasionally; other more common complications include migration/displacement, tissue reaction, lower lip incompetence, patient dissatisfaction, and infection, which may occur much later with chin than other facial implants [
A 27-year-old male presented with a functional and cosmetic concerns regarding his nose. His cosmetic concerns included a prominent dorsal hump and overprojection. He had a history of traumatic rugby impact on the nose but had never sought treatment. Functionally, he noticed nasal obstruction, worse at night. After confirming septal deviation with nasopharyngoscopy and proceeding to preliminary photographic visual planning, both the patient and the surgeon noted that a balanced facial aesthetic would require a specific correction of the patients microgenia to the mid facial plane (see Figure
(a) Photograph of the patient preoperatively. (b) Using visual photographic reconstruction to demonstrate facial augmentation—planned nasal dorsal hump reduction and augment chin into alignment with mid facial plane.
Photograph showing intraoperative findings of implant pressing on mental nerve.
Diagrammatic representation of intraoperative findings of chin implant (blue) inferior to mental nerve (yellow).
Implantech Conform extended anatomical chin implant used.
Chin augmentation or augmentation mentoplasty with synthetic implants was first introduced in the 1950s and has become an increasingly popular cosmetic procedure for chin retrusion or microgenia [
Complications of chin augmentation include infection, malposition of the implant (leading to patient dissatisfaction), and extrusion of the implant intraorally [
Chin augmentation with synthetic implants is a less complicated procedure than genioplasty which requires an osteotomy and replating and consequently is associated with less surgical morbidity [
Both transoral and external approaches have been described for the insertion of chin implants. A preference for the transoral approach is evident in the literature as it avoids an external scar, which had been reported to cause scar alopecia in males [
The surgical technique involves the creation of an optimally sized subperiosteal pocket in which the chin implant is placed, minimising the risk of implant migration [
Traumatic dislodgement and migration of chin implants is an unexpected complication and not normally reported in long-term morbidity studies. Our case highlights an unusual migration and as previously noted in the literature, an external submental approach to resite and/or secure the chin implant is recommended [
There have been no prior reported cases of mental nerve compression secondary to traumatic chin implant migration in the recent literature. This case highlights a potential complication to discuss with patients who participate in high risk activities for facial trauma such as contact sports. Mental nerve compression causes distressing symptoms for the patient and should be discussed when considering elective chin augmentation.
The authors declare that they have no conflict of interests.