ABSTRACT
If simultaneously performing other upper airway reconstructive procedures, the GA is
performed last to avoid blood altering visualization during these procedures. An injec-
tion of a local anesthetic solution containing 1:100,000 epinephrine is placed along the
planned labiogingival sulcus and floor of mouth for hemostasis. The labiogingival sul-
cus is incised with a knife blade to avoid postoperative dehiscence by thermal injury to
the mucosa from electrocautery (Fig. 7). A periosteal elevator raises the periosteum
and mentalis muscle from the mandibular cortex. Assessment of the depth of the
GGM insertion to the geniotubercle is determined by digital palpation of the floor
of mouth by the surgeon and by evaluating the panorex radiograph. The rectangular osteotomy is completed using an oscillating saw with the
parallel vertical cuts medial to the canine dentition (Fig. 8). The inferior horizontal
osteotomy is placed at least 6-8mm from the inferior mandibular border and the
superior osteotomy is placed 8-12mm above the inferior osteotomy. This osteotomy
is an estimated distance of at least 5mm below the incisor root apices, parallel to the
inferior osteotomy. The horizontal osteotomies are cut upward at approximately a
15 angle to ensure that all of the GGM fibers are incorporated in the geniotubercle fragment, especially with long dental roots. A 1.5mm hole is drilled into the center of
the geniotubercle fragment and a 2mm width and 10mm length titanium mini-screw
(Stryker-Leibinger, Portage, MI) placed.
